Pharmacists across Virginia are reporting questionable prescriptions for a suite of drugs that have been promoted as unproven treatments for COVID-19, the disease caused by a new strain of coronavirus.
On Wednesday, Virginia Health Commissioner Dr. Norman Oliver issued a letter warning of a “surge in demand” for medications commonly used to treat malaria, lupus, rheumatoid arthritis, HIV, and other conditions.
“This is leading to an inadequate medication supply for patients already taking these medications for chronic conditions and hospitalized COVID-19 patients being treated with these medications under facility-specific treatment protocols while studies are ongoing,” he wrote.
Virginia is far from the only state seeing a spike in requests. The drugs hydroxychloroquine and chloroquine — anti-malarials that are often prescribed to prevent flare-ups in patients with lupus and arthritis — have made national headlines since President Donald Trump touted them as potential treatments for coronavirus. Dr. Dave Dixon, an associate professor and vice chair for clinical services at the VCU School of Pharmacy, said doctors and patients have started requesting those specific medications as a preventive measure against the disease, despite no evidence that they’re effective in that capacity.
“There was a very small pilot study looking at hydroxychloroquine with some promising results,” he said. “As a result, you started having folks request prescriptions and wanting to take it for prophylaxis, which is not what they look at in the study at all.”
Overall, there’s been a significant increase in demand for hydroxychloroquine, chloroquine, and other pharmaceuticals being examined for their potential to treat COVID-19. Dr. Joshua Crawford, the director of clinical pharmacy services for Bon Secours Mercy Health System, said there’s even been requests for HIV medications such as Kaletra, a combination of two antiviral drugs that was used on a small group of COVID-19 patients in Singapore.
A larger, more recent study in the New England Journal of Medicine showed the medication wasn’t more effective at treating severe symptoms of coronavirus than standard supportive care. Crawford said most experts have “moved on” from hopes that HIV medications could be a cure for COVID-19, but the demand still hasn’t stopped completely.
“This is how desperate people are,” he added. “We’re grasping at studies that normally we would not pay much attention to.”
In his letter to clinicians, Oliver noted that there is currently no proven cure for COVID-19. The data from clinical trials is still so preliminary that the Centers for Disease Control and Prevention isn’t even recommending investigational treatments for patients with the disease.
But Crawford said that hasn’t stopped doctors and patients from pinning their hopes on certain drugs. Dr. Justin Vesser, the interim manager for ambulatory pharmacy at UVA Health, said there have already been a handful of unusual prescriptions for the medications included in Oliver’s letter. Crawford said Bon Secours pharmacists have observed physicians writing prescriptions for themselves or their family members, a problem that’s been reported in other areas of the country.
“I understand where they’re coming from, I just don’t think it’s something we can afford to do as a society right now,” he continued. While Virginia hasn’t banned the practice — an emergency measure taken by at least six other states — Oliver called on pharmacists to restrict certain medications in outpatient settings and pay particular attention to make sure prescriptions appeared valid.
Vesser said common warning signs could include a prescription for a lupus medication coming from an anesthesiologist, or a dentist — any provider whose scope doesn’t ordinarily include the disease.
“I think there are situations where they’re trying to get medication in the hands of people who need it,” he continued. “But it’s our job to do the same thing we’d do in any context, which is to make sure there’s a bona fide relationship between the patient, the provider and the pharmacist.”
Doctors hoarding prescriptions on a “just-in-case” basis is only part of the issue, Crawford said. Much of the demand for certain medications is driven by health systems across the country, all of whom are preparing for a major influx in COVID-19 patients.
While the CDC and federal Food and Drug Administration aren’t recommending treatments, Crawford said that doesn’t necessarily square with what doctors are experiencing in the field. Most providers and hospitals share dozens of messages a day and hold regular meetings to discuss emerging and experimental treatments. Hydroxychloroquine, for instance, is still being examined as a possible treatment in the United States and other countries. As a result, hospitals are stocking up on the drug to treat their own COVID-19 patients and people who are already taking the drug for chronic diseases.
“From a pharmacy standpoint, we’re trying to buy the meds that we think we’re going to need for the amount of people we expect to come in,” he said. “When everyone does that at once, it takes away the supply that’s out there. No one feels like we bought more than we’re going to use.”
Bon Secours is reserving its supply of hydroxychloroquine to hospitalized patients with severe and confirmed cases of COVID-19, and to patients of its retail pharmacies who take the medication for conditions such as lupus and rheumatoid arthritis.
Meanwhile, the national supply of many of these drugs is already running short. The American Society of Health-System Pharmacists added chloroquine and hydroxychloroquine to its shortage list on Tuesday. Christina Barrille, executive director of the Virginia Pharmacists Association, said one of her members had to obtain prior authorization from an insurance company before he could refill a patient’s regular supply of lupus medication.
It’s a growing concern for pharmacists across the commonwealth. As providers seek out experimental COVID-19 treatments, patients with chronic disease are suddenly at risk of losing the drugs they’ve depended on for years. The American Medical Association, American Pharmacists Association, and American Society of Health-System Pharmacists recently issued a joint statement condemning prescription stockpiling by health providers, writing that it could have “grave consequences” for the community.
“These treatments are based on patients having access to their medication on a regular schedule,” Vesser said. “And if we disrupt their ability to get them, that could set a lot of people back.”