Pharmacists call for urgent law to let them supply substitute medicines amid shortages

Irish Pharmacy Union president Dermot Twomey in Cloyne, Co Cork: “[I]f an antibiotic is prescribed for a child but that is short — like, at the moment, Calvepen liquid — as pharmacists, we could substitute for an alternative antibiotic.' Picture: Eddie O'Hare

A crisis in procuring medicines, with hundreds of them unavailable or in very limited supply, has sparked calls from the Irish Pharmacy Union for emergency legislation to allow pharmacists to supply substitute medications without GP approval.

Shortages of 219 medications are listed today, including children’s antibiotics, painkillers such as paracetamol, tramadol, and morphine, statins, allergy medications, and nicotine replacement therapies.

 Pharmacists have been left scrambling to secure what limited supply of medications they can and spend hours each day on the phone to already overstretched GPs suggesting alternatives to unavailable products.

Irish law currently does not allow pharmacists to provide therapeutic substitutions. These must be prescribed by a medical doctor.

But a 'serious shortage protocol', if introduced by the Government, would allow pharmacists to substitute medications such as antibiotics and painkillers in line with set protocols.

Irish Pharmacy Union president Dermot Twomey, who is a pharmacist in Cloyne, Co Cork, said the protocol would negate the need for the pharmacist to revert to a GP.

“So if an antibiotic is prescribed for a child but that is short — like, at the moment, Calvepen liquid — as pharmacists, we could substitute for an alternative antibiotic, based on a protocol.”

The serious shortage protocol already operates in the UK and was discussed as an option for Ireland when hormone-replacement therapy drugs ran into acute short supply last May.

‘There are always medicine shortages, it’s how things have been for years, but it’s particularly acute at the moment,’ says Barry Broderick at his pharmacy on Barrack St in Cork.  Picture: Eddie O’Hare

However the protocol was never implemented.

Supply is so tight that Broderick’s Pharmacy on Barrack St in Cork has someone checking with Ireland’s two drug warehouses every 15 to 20 minutes in case more supplies have come.

“If a medication is back in, you pounce and try to get enough for the month,” owner and pharmacist Barry Broderick said.

“That probably has a spiral effect — if everyone jumps in and gets a month’s supply in one go, other people will be left short. .

“There are always medicine shortages, it’s how things have been for years, but it’s particularly acute at the moment.

“The worst from our point of view is all oral liquid children’s antibiotics — amoxicillin in particular — they were just unavailable over that crazy spell between mid-December and last week.

“There’s been an incredibly big spike in illness so all the wholesalers were running out.

“All the alternatives were running out so we were breaking apart capsules to try to get antibiotics for the children, improvising any way we could while working within all the rules and regulations.”

He said that took up a lot of time.

“Every time you had a sick child you had to figure out how you’d provide the child with an antibiotic.

“The doctors are up the walls as well. The last thing they need is to be called off their regular tasks just to try to find an alternative in what should be a very straightforward transaction.”

“In the UK, the pharmacists are allowed to make a substitution themselves without bothering the doctor, which is something we’d advocate strongly.

“But legally we’re not allowed yet. It would speed things up for the patient, and the doctor wouldn’t have to deal with trivial questions on the phone.”