When President Donald Trump repeated his encouragement by anecdotal evidence of malarial drugs being used to treat or prevent COVID-19 on Wednesday, March 18, some states saw a run on the medications. Others even saw deaths related to individuals taking matters into their own hands, ingesting the drugs independently of medical supervision.
But not Idaho.
Why? Because Governor Brad Little acted quickly, encouraging the Idaho Board of Pharmacy to limit the drugs. It’s called “temporary rule 704” and adds restrictions to access to rheumatic treatments, avoiding a shortage and the hoarding that has happened in other states.
“What the temporary rule does is it prohibits the dispensing of a medication for chloroquine or hydroxychloroquine unless three things happen,” said Alex Adams, administrator for the Idaho State Division of Financial Management and previously the administrator for the Idaho Board of Pharmacy from 2015-2018. “First, is there has to be a diagnosis on the prescription. A lot of what other states found is that as some evidence of efficacy of these drugs came out, there were large runs on these drugs from prescribers writing prescriptions for their family members with no known diagnosis, so it requires a diagnosis on the prescription. It does limit the prescription to a 14-day supply, and it limits refills, no refills are allowed.”
But what exactly are these drugs? Chloroquine and hydroxychloroquine are medications created to fight malaria but have found other uses in the last 70 years, treating rheumatic diseases like rheumatoid arthritis or lupus.
“Particularly with hydroxychloroquine, it’s a cornerstone drug in the treatment of lupus,” said Dr. Leslie Jackson, vice president of medical affairs for Saint Alphonsus Medical Group rheumatologist in Baker City, Oregon. “We know it prevents flares of disease. It prevents what we call ‘damage accrual’ in body organs, so joints, lungs, heart, and it also has been shown to prolong survival in patients with lupus.”
But how did this “cornerstone drug” for lupus turn into a treatment for the novel coronavirus? Jackson says it started with rumors of favorable results in treatments for patients suffering from the effects of the brutal COVID-19 virus.
“Some people are taking it as prophylaxis to try and prevent the infection; others are taking it after they’ve potentially been exposed,” she said. “There are two clinical trials that are open right now; they’re recruiting patients, one is in Minnesota, the other is in New York and looking at if this drug is given after someone has been exposed, will these prevent the infection from taking hold.”
And in the field of medicine, those trials are essential. While anecdotal evidence may sound like enough to pivot with an FDA-approved drug and use it for patients who are dying, it’s not quite that simple, according to Jackson.
“It is important to know whether they truly work because these drugs, they’re not a free ride, there are potential side effects for any of these medications,” she siad. “We’re looking to make sure that hopefully, they will decrease burden, may prevent more serious complications, and prevent death, but we really need more clinical solid data before we can just prescribe these without any other facts.”
Adams says the rule limits the access to the drugs to prospective COVID-19 patients, but the Board of Pharmacy worked to make sure the rule doesn’t affect current patients who may rely on the medicines for life-saving treatment.
“Of course, the exceptions to those (limitations) are individuals who had been established on these medications prior to the effective date of the rule, so those patients with rheumatic conditions who depend on these medications can still access those medications as they traditionally had. Those limits do not apply to them,” he said.
While the rule has only been in place for less than a week, Adams said they’ve already heard from pharmacists with encouragement.
“The board of pharmacy has done a really good job of communicating out this new temporary rule to their licensees and we’ve heard a lot of positive anecdotal evidence from pharmacists saying, ‘thank you, this has helped us preserve our supplies so we can continue to help our patients in need,” he said.
Meanwhile, Dr. Jackson says her patients are reaching out to her in fear, concerned the medicines on which they depend could end up hoarded and unreachable to the individuals who need them.
“I know that my patients earlier this week after they’ve heard what’s going on have called my office in a panic wondering if they’re going to be able to get their medication,” she said.
She encourages the public to wait, even when waiting may be difficult until researchers complete the testing, and the side effects for patients suffering from the novel coronavirus are known.
“I think we have to be patient,” said Jackson. “Everybody wants to know what we can do right now, but the CDC has guidelines about prevention and, of course, handwashing is number one, we’re social-distancing and really paying attention to what the evidence is showing.”
And the Governor may act again, as other evidence and encouraging anecdotes spread about the power of other medicines related to the treatment of the pandemic.
“The other medication that’s come out in recent days as having some potential efficacy is azithromycin, a lot of people know it as ‘Z-paks’,” Adams said. “So the board of pharmacy is currently looking into action and probably will take action (Tuesday or Wednesday) on that medication as well.”
For now, people who rely on medications can be comforted in knowing there’s not currently a shortage of medicines, only a shortage of specific pharmacies and their supply. And none of those shortages are affecting Idaho pharmacies.
Patients who are running low on any of their drugs, from chloroquine and hydroxychloroquine to any other myriad medications on which people rely, can know there are other actions by Governor Little, which could help them access the medicines they need.
“They are allowing emergency refills of any medication,” said Adams. “So, any medication that a patient was on for a chronic condition such as diabetes or blood pressure or cholesterol, they can go to any pharmacy in the state and get an emergency refill of those because we know there’s a lot of pressures on the healthcare system right now and if the patient was out of their diabetes medications, they might not get into their physician’s office in the short term.”