Bitter pill: how Brexit could interrupt medical supplies

With Brexit looming and time running out for a negotiated withdrawal from the EU, what does this mean for our medicines supply?

Trade between the UK and the EU is substantial, as medicines and medical devices are delivered to patients across Europe. Some 45 million patient packs go to the EU from the UK every month, so clearly medical supply chains will be affected in the event of a no-deal exit.

The efforts of Government, agencies such as the Health Products Regulatory Authority (HPRA) and individual pharmaceutical companies notwithstanding, there are bound to be supply problems with a small number of medicines. The exact number (and names) of drugs on an official "concern" list has yet to be revealed, but reports in The Irish Times have indicated some 50 medical preparations have been identified.

Even before Brexit began to cast its shadow on our lives, the HPRA published a regularly updated list of shortages affecting the Irish market. So at present there is a supply problem with adrenaline auto-injectors, used by people with severe allergies to prevent reactions reaching a life-threatening stage. Other medications on the current shortage list include a range of cardiac drugs, intravenous preparations of the anti-viral drug acyclovir, the cancer drug fluorouracil and the antibiotic trimethoprim. In most cases the agency is able to state when normal supply will resume, although for some drugs the shortage is open-ended.

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Short half-life

Brexit may also pose a threat to preparations used in medical investigations, such as dyes and nuclear medicines. Drugs manufactured in Britain with a short half-life, meaning there is a short time between manufacture and use by the patient, are an obvious source of concern. Some drugs, especially vaccines, must be transported at a set temperature and arrive with evidence of an uninterrupted cold chain in order to be considered safe to use. They are vulnerable to backlogs at ferry ports.

What are the implications of a patient not being able to source a prescribed medication?

There are many variables: among these are the illness for which the drug has been prescribed; whether the disease is considered mild, moderate or severe; and whether the disease is an acute or chronic one.

One doesn’t require a medical degree to come up with a number of illness scenarios where even a short-term interruption in the availability of a medicine could have serious and even life-threatening consequences. The person with type 1 diabetes treated with injectable insulin would certainly be vulnerable, as might a patient in the middle of a cycle of chemotherapy for the treatment of cancer.

A useful way to assess the possible impact of an acute Brexit shortage of medicines is to consider for which drugs is it inadvisable to stop treatment abruptly. For example, when antihypertensive medications are suddenly stopped, it can cause a marked spike in blood pressure, which in turn increases the risk of stroke.

Beta blocker

One particular cardiac drug that must not be withdrawn abruptly is a beta blocker, used to treat heart failure, high blood pressure and angina. Suddenly stopping a beta blocker increases the chance of sudden cardiac arrest, heart attack and stroke. The dosage is usually tapered off when the drug is being discontinued.

Steroids are another class of drug where it is advisable to taper the dosage. The most powerful anti-inflammatory agent in the drugs armamentarium, steroids are used to treat asthma, arthritis and inflammatory bowel diseases such as Crohn’s. Over time steroids decrease the body’s natural steroid production. This means that after a prolonged period of taking steroids, your body may not be able to immediately produce steroids on its own when it needs to. In addition to causing a flare-up of symptoms, abruptly stopping steroids may cause widespread collapse across a number of body systems.

Finally, don’t stockpile medications in advance of Brexit.

Doing so will merely create shortages where none exist.

mhouston@irishtimes.com