Intended for healthcare professionals


Crisis in the supply of medicines

BMJ 2019; 367 doi: (Published 04 October 2019) Cite this as: BMJ 2019;367:l5841

Linked Opinion

Securing regular medications is a lottery every month

Linked Letter

Brexit and medicine shortages: evidence from trade data

  1. R E Ferner, honorary professor of clinical pharmacology1,
  2. J K Aronson, clinical pharmacologist2,
  3. C Heneghan, professor of evidence based medicine2
  1. 1Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
  2. 2Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to C Heneghan carl.heneghan{at}

Drug shortages have complex causes and important clinical and economic consequences

Shortages of medicines may harm patients by depriving them of treatment or forcing them to use different products.1 Pharmacists cannot legally substitute alternatives without consulting prescribers and may have to refer patients back to their clinician. Errors are also more likely when doctors prescribe unfamiliar medicines and when patients take them—a shortage of lomustine in France led to unintentional overdoses when a different product was substituted.2

The prospect of Brexit has raised concerns about possible UK shortages of medicines. However, shortages are already common globally. Australian prescribers face critical shortages of 56 medicines3; around 5% of licensed medicinal formulations are unavailable in Belgium4; in 2018 there were 769 shortages in the Netherlands5 and the French regulatory agency managed 871 shortages, compared with 405 in 20166; and in the US 213 drugs are currently in short supply.7 In the UK over 900 formulations have been in short supply at some point since 2014, for periods of weeks to months, some indefinitely; current shortages include hormone replacement therapy, oral contraceptives, …

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