Worries about access to medication are mounting after the release of the government’s Yellowhammer report on Wednesday, detailing worst case scenarios in the event of a no-deal Brexit.
Fin McCaul, a community pharmacist in Manchester, tells HuffPost UK a customer asked him for a “lifetime supply” of medication for their heart condition this week.
Several other pharmacists say they’ve been busy reassuring patients who are anxious about how they’ll get hold of medicine in the coming months.
Reports of people stockpiling medicines first emerged at the beginning of this year. However, as the new Brexit deadline of 31 October looms, and with parliament prorogued (suspended) for five weeks, the level of panic is rising.
A key section of the Yellowhammer report suggested that medicine distribution flow across the short Channel straits (the main English Channel crossing into Dover) could be as low as 40% with “significant disruption lasting up to six months” after the withdrawal date.
Three-quarters of medicines come via the short straits.
The community pharmacists we spoke to insist that while they cannot know how things will pan out after Britain leaves the EU, preparations are in place to reduce disruption – and most of them are confident in the Department of Health and Social Care’s plans.
However, cracks are beginning to show. Shamir Patel, a pharmacist at online pharmacy Chemist 4 U, said his business is currently struggling to access medications including: epileptic medication (Epilim, Keppra); contraceptives (Yasmin, Microgynon, Cerrazette); and medicines for some mental illnesses (Escitalopram, Mirtazepine).
There have also been severe shortages of hormone replacement therapy (HRT), prompting fears that some menopausal women are experiencing knock-on mental health issues or are even at risk of becoming suicidal.
The HRT shortage isn’t related to Brexit, according to McCaul, but is a result of multiple manufacturers having problems at the same time. “Any of the major issues we’ve had to date have nothing to do with Brexit at all,” he said – but adds that they are unlikely to be resolved “for a few months”.
Ade Williams, lead pharmacist at Bedminster Pharmacy in Bristol, says he is also “seeing a lot more shortages” in the medicine supply chain at the moment, but agrees they’re not linked to Brexit, but general issues in the global market.
Ordinarily, he notes, these shortages wouldn’t make the news.
The Context
McCaul described the medicine supply chain as “really complicated” and said “when something goes wrong in one part of the chain it can have a roll-on effect to the other parts of it”.
This was the case in 2018 with the anti-inflammatory drug naproxen, used to treat pain and inflammatory diseases such as rheumatoid arthritis. An issue with one of the drug’s active ingredients last year led to a worldwide shortage.
Any issue with a particular ingredient, the packaging or safety information can impact the whole supply. “A lot of the medicines are not necessarily made in the UK but are made in one or two factories worldwide for worldwide supply – that could be anywhere in Europe, China, India, wherever,” says McCaul.
Conversely, the UK – and England in particular – has some of the cheapest medicines in the market. “Community pharmacies worked hard in negotiating down tariff prices with manufacturers to make the UK one of the best value sources of drugs,” McCaul explains. “When there’s a shortage worldwide, the UK then tends to be the last place the manufacturers will put the stock into, purely because they can get a better return somewhere else.”
So, the medicine supply chain is global and complex – and it is also fragile.
That’s not to say existing issues with supply bode well in the context of Brexit. Earlier this year, Ash Soni, president of the Royal Pharmaceutical Society, told the BBC he had never seen so many commonly used drugs affected by shortages. Some of these included painkillers and anti-depressants.
Rising Anxiety
With shortages more widely reported, and with the heightened rhetoric around Brexit in the political and public sphere, patients are understandably worried.
“Every one of us will filter the news that we receive constantly in the context of ourselves,” says Williams. “What supply and goods means to you and I will be different to a 69-year-old cancer patient who is going to be thinking: 'Am I going to get my medicines or not?’
“And when those supply issues happen, it feeds into that anxiety. Then you tell three other people and the uncertainty that persists creates more reasons for people to be worried – and that creates more pressure on the pharmacies.”
Uncertainty around Brexit has been causing anxiety levels to surge for some time now. Earlier this year a survey by the British Association for Counselling and Psychotherapy (BACP) found one in three Brits believed it was having a negative impact on their mental health.
For some people whose lives depend on medicine, the uncertainty is leaving them with no other option but to stockpile. This can cause shortages and is problematic in that some medicines have short shelf lives. If stockpiled, they may end up being wasted when other people could be using them.
Patients who rely on medicine from the EU launched a campaign last week to highlight how, as they see it, the government is putting their lives “at risk”, using the hashtag #deathbybrexit and putting a black dot on their Twitter bios.
In recent weeks, various lists have also been doing the rounds on social media suggesting the types of medication that could “possibly be affected by Brexit”. One such list, originally created by online pharmacy e-surgery, has been shared thousands of times and includes medicines for high blood pressure, antidepressants and even dispersible aspirin.
Dr Oskar Wendowski, e-surgery’s managing director, told HuffPost UK in an email that the list includes medication the company has either had trouble sourcing, that suppliers have expressed availability concerns about – or whose wholesale price has gone up rapidly in recent weeks.
According to Wendoswki, “the general idea of the article was to raise awareness for patients so that they have alternatives in mind if necessary”.
But DHSC said the list was sparking unnecessary worry. “We do not recognise this list and its irresponsible publication creates needless concern for patients,” a DHSC spokesperson told HuffPost UK.
“We are taking all appropriate steps to prepare for Brexit on 31 October, whatever the circumstance, and our plans should help ensure the supply of medicines and medical products remains uninterrupted.
“There is no evidence that any current supply constraints are related to EU Exit.”
So, What Next?
In the Yellowhammer document, DHSC said it is developing “a multi-layered approach” to mitigate risks associated with leaving the EU.
A list of their action points, shared with HuffPost UK, includes stockpiling where possible, securing additional freight capacity and changing or clarifying regulatory requirements.
Other steps include procuring additional warehousing, working closely with the industry to improve trader [ie. pharmacy] readiness and putting in place the National Supply Disruption Response to manage potential shortages.
The DHSC is also in the process of procuring an express freight service which would bring medicines to the UK within 24 to 72 hours, if required, following Britain’s planned withdrawal from the EU on 31 October.
Ultimately, nobody really knows what will happen next. And while pharmacists scrabble to put in place procedures that will help in the event of shortages, such as speaking to local surgeries and pharmacies about sharing stock, it’s clear they have very little control over the situation.
“The question is: are we ready? Is the system ready? Are all the bits that need to work together to do this working well?” says Ade Williams in Bristol. “We can only say what we’re doing. We have no choice, we just have to keep working with our patients.”
Advice from pharmacists for patients
:: Order regular medicines on time, don’t leave it to the last minute.
:: Don’t try and stockpile medicines.
:: You can also order medicines online through some pharmacies – speak to them about setting up processes to manage that.
:: If there is a shortage, speak to your pharmacist or GP who may be able to provide alternatives.