A young woman with severe depression was told without warning she would have to go for more than three weeks without the medication that saved her life because of supply problems caused by Covid-19.
Her mother accepts the explanation for the shortagebut questions why Pharmac knew of the low supply in February, yet her daughter only found out at a pharmacy in May.
Pharmac, the government agency which decides which medicines are funded in New Zealand, says the prescriber was responsible.
Lisa Williams, director of operations at the agency, said Zyban – the medication in question – was approved for people who want to quit smoking, not as an anti-depressant.
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Because Pharmac couldn’t track who used the medication for off-label purposes, it didn’t have a way of knowing who could be affected, she said, and the agency didn’t have a direct link to GPs.
But an update on supply issues is sent to the Royal New Zealand College of General Practitioners each week to be sent out to members as part of the college’s weekly communications, and an online database updated once a month informs GPs of medicine availability and any other relevant information.
One focus of Government probe will be whether the drug-buying agency is making decisions on new medicines quickly enough.
However, Dr Bryan Betty, the college’s medical director and a GP himself, said the 5,500 family doctors who care for millions of Kiwis couldn’t be expected to keep on top of medication availability.
“We’ve seen a lot about stock and supply chain issues running out … it’s happening quite often.
“Frontline GPs are often unaware of stock issues … sometimes they are [Pharmac] basically put out a bulletin with a whole lot of stuff … GPs are bombarded with information every day. ”
He said overwhelmed GPs could not be expected to cross-reference the availability of each drug for each patient – which could involve calling individual pharmacies – on top of their regular duties.
“Usually the first we’re aware of it [low or no stock] is when a patient goes to put through their script at the pharmacy.
“It’s a real challenge, and one Pharmac needs to do a lot more thinking about.”
Zyban is one of 30 medications which has had supply issues, according to Pharmac’s website, much of which was caused by Covid-19.
Other items include baby formula and treatments for arthritis and high blood pressure.
Jan, whose daughter Sarah – neither is their real name – faces going without her medication, said she understood Covid-19 had disrupted the global supply chain, but felt if Pharmac was aware of supply issues months ago, more should have been done to spread awareness.
“Why wasn’t it on every platform? Why isn’t there a public alert system?
“They know what it can be used for. There could be people all around the country struggling, and we don’t know. “
Sarah started using Zyban as a teenager after three years of psychiatrist and mental health ward visits. She’d been considered “treatment resistant”.
“She was horrendously suicidal … then she went on Zyban.
“She hasn’t had to see a psychiatrist in 18 months. She’s stable after years I didn’t think she’d survive. “
Last Tuesday Sarah, who was unavailable for comment, went to the pharmacy for her fortnightly prescription and was told they would be out of stock until the end of May.
“She had no notice, just, ‘Oh, we don’t have these,'” her mother said. “When she was discharged from mental health services there was a note specifically saying not to stop taking them.”
Four years of stability on Zyban afforded Sarah the mindset to finish school and become a registered nurse.
She had a supply for a couple of weeks stashed away in an emergency kit, but it was precaution Jan didn’t think many others would have made.
Betty said anyone facing a period of time without their usual medication should immediately book an appointment to discuss next steps.
Health and Disability Commissioner Morag McDowell said confusion over who was responsible for managing and communicating brand changes to consumers was nothing new, “with a blurred line between Pharmac, prescribers, and pharmacists.”
In 2019, complaints regarding a brand change of anticonvulsant drug lamotrigine prompted an investigation by the Health and Disability Commissioner.
A letter to the Director-General of Health with the findings prompted the Ministry of Health to set up a multi-agency group to improve that system. The work is ongoing.
WHERE TO GET HELP
Lifeline (open 24/7) – 0800 543 354
Depression Helpline (open 24/7) – 0800 111 757
Healthline (open 24/7) – 0800 611 116
Samaritans (open 24/7) – 0800 726 666
Suicide Crisis Helpline (open 24/7) – 0508 828 865 (0508 TAUTOKO). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.
Youthline (open 24/7) – 0800 376 633. You can also text 234 for free between 8am and midnight, or email email@example.com
0800 WHATSUP children’s helpline – phone 0800 9428 787 between 1pm and 10pm on weekdays and from 3pm to 10pm on weekends. Online chat is available from 7pm to 10pm every day at www.whatsup.co.nz.
Kidsline (open 24/7) – 0800 543 754. This service is for children aged 5 to 18. Those who ring between 4pm and 9pm on weekdays will speak to a Kidsline buddy. These are specially trained teenage telephone counselors.
Your local Rural Support Trust – 0800 787 254 (0800 RURAL HELP)
Alcohol Drug Helpline (open 24/7) – 0800 787 797. You can also text 8691 for free.
For further information, contact the Mental Health Foundation’s free Resource and Information Service (09 623 4812).