Crisis in the supply of medicines

Ferner et al highlight current drug shortages in the UK and worldwide, and note that “Sometimes alternatives will be identifiable, but there will often be therapeutic and financial costs.” (1) The example of naproxen shortages illustrates this. From September to December 2018, prescribing of naproxen in English CCGs fell from 581,927 items to 480,171 items (a 17.5% fall). In September 2018, naproxen prescribing cost £1,495,703 – by January 2019 it had risen to £9,206,903, despite reduced prescribing. (2) Apart from these financial costs, there was a regrettable shift in prescribing, as the proportion of NSAIDs with greater risks of cardiovascular, gastrointestinal, and renal adverse effects rose. The “Number of prescription items for all NSAIDs excluding ibuprofen and naproxen as a percentage of the total number of prescription items for all NSAIDs” rose from 20% in September 2018 to 24% in January 2019. (3) The management of prescribing during drug shortages needs careful thought, and timely advice, to avoid sudden increases in the risks of harms to patients.

1. Ferner RE, Aronson JK, Heneghan. Drug shortages have complex causes and important clinical and economic consequences. BMJ 2019;367:l5841
2. OpenPrescribing.net, EBM DataLab, University of Oxford, 2019 https://openprescribing.net/chemical/1001010P0/
3. OpenPrescribing.net, EBM DataLab, University of Oxford, 2019 https://openprescribing.net/measure/ktt13_nsaids_ibuprofen/all-england/#...