If you’ve been reading for a while, you might remember some posts about nationwide shortages of drugs. The Food and Drug Administration was concerned, and so were very senior physicians working in infectious disease, cancer, everyday emergency medicine and even veterinary care.
The crisis faded from view, as they do. So it wasn’t much noticed that back in March, the American Academy of Pediatrics warned of an FDA alert over an apparent shortage of doxycycline, an old and inexpensive drug that is used mostly for uncomplicated infections such as sexually transmitted diseases and acne. It is also used, though, as the first treatment for a new case of Lyme disease — and that, more than anything, has sparked alarm.
Lyme is a problem mostly in the northeastern US and also the upper Midwest (though other little-noticed tickborne infections occur in the southeast and on the West Coast). Maine is one of Lyme’s hotspots, and last week the Bangor Daily News reported:
“We’ve had availability, but the price is going up and that’s obviously a concern, too,” state epidemiologist Stephen Sears said. “And, sooner or later, if it’s getting to be short nationally, it’s going to get short here, just as other drugs have.”
He said the department has heard Doxycycline’s price is now five to 10 times higher than it used to be, but he said that is hard to gauge because pharmacies all price differently and insurance companies pay differently.
Senators from Maine and Minnesota urged the FDA last week to do what they can to alleviate the problem — which seems to be a combination of higher demand and reduced supply from the manufacturers. According to the FDA’ s running tally on shortages, of the four distributors of doxycycline, one can’t get any until September, and one has restricted its sales to its current contract customers only.
Last night, this issue showed up in my Twitter feed. Dr. Judy Stone, who practices in western Maryland and Maine (and blogs at Scientific American) announced the price of the drug at her hospital community pharmacy had gone from $20 to $3,000.
Here’s the conversation that ensued. Participants are physicians Eli Perencevich and Amesh Adalja, and investigative journalist Katherine Eban, who knows more than anyone about the internal complexities of drug manufacturing.
In practical terms, what does this mean? (Other than that drug manufacturing in the US is broken. But we knew that.) If you live in an area where you are likely to be exposed to tickborne diseases — which, frankly, is most of the US now — it’s more important than ever to take the steps to protect yourself; the easy fix of a quick cure may not be available when you need it. After that, hope that no national disease emergency occurs; as Dr. Adalja pointed out in a paper last year, doxycycline is a key component of biodefense campaigns as well.
Meanwhile, if you’re a physician or pharmacist who is experiencing these shortages or price increases, it would be great if you would let me or Dr. Stone know, in the comments here; through the email link under my byline up top; or via @marynmck or @drjudystone.