Spokane pharmacist Dan Reidt is kicking himself for not seeing the shortage coming.
Hart & Dilatush Pharmacy only has a few chloroquine tablets left – not enough to fill a single prescription – and the two wholesalers they order from are out.
Chloroquine shortages rippled through Spokane and across the nation after President Trump erroneously claimed last week that the Federal Drug Administration had approved the antimalarial, arthritis and lupus medication to treat COVID-19.
The confusion among people regarding chloroquine is blamed in the death of an Arizona man this week after he attempted to self-medicate by mistakenly taking a toxic form of chloroquine that is used to clean fish tanks.
There are still no FDA-approved therapeutics for coronavirus, though research underway does show chloroquine could be helpful at certain stages of the disease, according to a statement released this week from the Washington Medical Commission.
When Reidt saw hopeful reports about the drug, he was just relieved.
“I wish I’d thought about it for two seconds and just pressed the button to order one more bottle,” Reidt said.
Now he worries for his patients who rely on the drug for lupus and arthritis treatment. And if those patients turned to a different pharmacy, they wouldn’t have much luck.
“Things are going crazy with chloroquine right now,” said Dr. Lauren Lyles, executive director of the Washington’s pharmacy commission.
Though there are now reports the chloroquine shortage has been “resolved,” Lyles said that’s not what she’s hearing on the ground.
All of Sixth Avenue Pharmacy’s suppliers are out of chloroquine and hydroxychloroquine, pharmacist Erik Nelson said. For now, the pharmacy has 4,000 hydroxychloroquine tablets stocked, which would enough to treat about 70 people for the virus using an experimental 60-tablet protocol.
“By summertime we’re going to be in trouble if we still can’t get more,” Nelson said.
He’s not optimistic that the shortage will let up.
At the same time that orders of chloroquine rose 3,000% in March, according to data from a health care consulting organization, pharmaceutical factories shut down in China and India due to the pandemic.
“It’s super scary what’s going on with our supply chain,” Nelson said. “If we’re smart as a country, we’ll learn from this and bring our drug manufacturing back to the United States so we can control it.”
Chinese manufacturers supplied more than 90% of the United States’ antibiotics and large percentages of other pharmaceuticals in recent years, according to Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.
But there’s a silver lining: Pharmacists could make up for low chloroquine supplies by compounding the medication, Nelson said.
Compounding is a process in which pharmacists use raw powders of active ingredients plus fillers to make custom prescriptions for patients. At Sixth Avenue, they can compound 300 tablets in one batch.
“If all the compounders in the United States were to compound hydroxychloroquine, I would think they could easily provide enough in a week,” Nelson said.
But they can’t make the tablets without personal protective equipment (PPE) like masks and gloves, where even more dire shortages have been reported.
Under Washington law, pharmacists must wear PPE to compound drugs. If pharmacists lose access to masks and gloves, they could be blocked from compounding altogether during the crisis.
“We’re told that Washington state is dangerously close to not having enough PPE to fill the requests for supplies for hospitals and clinics,” Jeff Rochon, CEO of the Washington State Pharmacy Association, said last week.
The Washington State Pharmacy Association was working last week to bring new guidelines to the pharmacy commission that would allow pharmacists to continue compounding drugs when PPE run out, Rochon said. The change would authorize medical workers to compound using sterile methods, such as alcohol wipes and swabs, instead of PPE in emergencies.
In the meantime, the pharmacy commission is working to track drugs like chloroquine in Washington to measure supplies, Lyles said. Tracking pharmaceuticals is normally a task outside the commission’s scope, but low supplies of hydroxychloroquine are grabbing the commission’s attention.
Chloroquine is an old drug, and it has a history of running out, Lyles said. Not so with hydroxychloroquine.
“Hydroxychloroquine is just the new kid on the block and people are trying to take advantage of it in some way,” Lyles said. “So we’re trying to track that because I think everyone is in panic mode.”
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