Curtains down, doors closed, green cross unlit. It was particularly difficult to obtain medicine last Thursday in France. Nine out of ten pharmacies were closed. A massive strike, motivated by wage demands, the refusal of market liberalization and the urgency of putting an end to the shortages which persist in the country.
“Medicines in shortage, patients in agony”, we could read in the processions. A particularly well-intentioned slogan: complications, errors, deaths… published on May 15 in the magazine European Association of Hospital Pharmacists, a study reveals significant health consequences linked to supply problems.
In 2023, 5,000 medicines were reported as “out of stock” or at “risk of stock out” by the National Agency for the Safety of Medicines and Health Products (ANSM). There were only 3,761 in 2022, and 2,160 the previous year. Far from being a simple inconvenience, which requires running from one pharmacy to another, this publication demonstrates that these tensions on supplies can lead to serious consequences on health. Including when, as in most cases, alternative solutions are found.
224 incidents in two years
Over the 2020-2021 period, 224 incidents attributable to shortages were recorded. In 59% of cases, these were adverse effects linked to a change in treatment, and medication errors for nearly a quarter of them, point out the authors, pharmacologists specializing in pharmacovigilance (monitoring medication).
These complications remain rare given the number of patients treated each year, but they can be dramatic. Another study by the same authors, published in 2023 in British journal of clinical pharmacology, underlines this. Around thirty people were in danger of death over the period 1985-2019. “Replacing one drug with another is not trivial,” underlines Aurélie Grandvuillemin, pharmacologist at Dijon University Hospital, one of the co-authors of the two publications.
A patient, accustomed to taking an entire box for his cancer treatment, did not realize that he had changed. He died after an overdose. Another saw his skin blister, he was allergic to the substitution, a hypertensive in the same family. And there are all these chain consequences, which are difficult to predict: due to a lack of antihistamine, a patient developed an allergy to his chemotherapy and had to stop it.
Deaths and complications
Due to complex, multiple and long treatments, cancer patients are the main affected, explained Joël Ankri, professor emeritus at Paris-Saclay University, in 2022 in Public health news and files. “Despite the existence of substitute medicines, shortages lead to a loss of opportunity for patients and […] a deterioration in five-year survival,” he wrote, citing a declarative study carried out by the League against Cancer carried out in 2019, when shortages were still rare.
Outages also push caregivers to deviate from usual channels, which increases the risk of coming across counterfeit or poor quality products. “There are therefore real actions to be taken, if only by securing alternatives, by improving patient information and monitoring systems,” indicates pharmacologist Aurélie Grandvuillemin. Especially since in 18% of reported incidents, the medication in question had not been reported.
The challenge of a scientific list
“The consequences are not only linked to drugs listed on the lists of products of major therapeutic interest or essential drugs,” also recalled the French Society of Pharmacology and Therapeutics (SFPT), in a notice dated May 27, issued in reaction to the publication of the pharmacovigilance network study. The text pleads for additional measures to combat shortages, while at the start of 2024, a new “road map” had already been announced by the executive, with relocations and price increases of purchase.
A list of “essential” medicines has also been published by the Ministry of Health, to strengthen surveillance. But many scientists have expressed concern about its reliability. “We must become aware of the challenge of establishing serious, scientific selection criteria, based not on industrial criteria, but on medical ones,” believes Professor Mathieu Molimard, pharmacologist at Bordeaux University Hospital, and spokesperson for the SFPT. These recent studies could help.
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