tag:theconversation.com,2011:/us/topics/drug-supply-75316/articlesDrug supply – The Conversation2022-03-23T19:06:55Ztag:theconversation.com,2011:article/1786082022-03-23T19:06:55Z2022-03-23T19:06:55ZTwo years into the pandemic, why is Australia still short of medicines?<figure><img src="https://images.theconversation.com/files/453710/original/file-20220322-17-1qyxhns.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/zaragoza-spain-december-2021-covid-test-2096748151">Alex Bascuas/Shutterstock</a></span></figcaption></figure><p>This might be a familiar scene. You pop into your local pharmacy to fill a script and you’re told your regular medicine is out of stock. When will it be in? Sorry, we don’t have a date. But I’ll ring up your GP to see if she can authorise an alternative. </p>
<p>This is a common conversation more than two years into the pandemic. So why, when our borders are open and planes are arriving from overseas with medicines on board, do we still have medicine shortages?</p>
<p>This may be surprising, but medicine shortages have been an ongoing issue in Australia. The pandemic only made it more visible. </p>
<p>For my <a href="https://vuir.vu.edu.au/view/people/Ziaee=3AMaryam=3A=3A.date.html">PhD research</a>, I looked at Australia’s pharmaceutical supply chain – the process of how medicines get from manufacturers to wholesalers and then to pharmacies.</p>
<p>I interviewed 20 supply-chain experts from 15 Australian and multinational companies. Here’s what I found, and what we could be doing better.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-heard-covid-is-leading-to-medicine-shortages-what-can-i-do-if-my-medicine-is-out-of-stock-153628">I've heard COVID is leading to medicine shortages. What can I do if my medicine is out of stock?</a>
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</em>
</p>
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<h2>If it’s not the pandemic, what’s going on?</h2>
<p>The <a href="https://apps.tga.gov.au/Prod/msi/search?shortagetype=All">Therapeutic Goods Administration database</a> lists shortages of 263 medicines, with a critical shortage of 27 of them. Shortages of 65 more medicines are expected. The list is updated daily. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1410858531364954113"}"></div></p>
<p>However, the pandemic is not the root cause of medicine shortages. So
border openings will not solve the problem.</p>
<p>Even before the pandemic, we were regularly seeing <a href="https://pubmed.ncbi.nlm.nih.gov/27383246/">medicine shortages</a> at similar levels.</p>
<p>The pharmaceutical industry is fundamentally different from other industries. Developing medicines is an extremely lengthy process, with no guarantee of success. Some 90% of candidate drugs <a href="https://www.nature.com/articles/nrd.2016.136">don’t complete clinical trials</a>. Of those that do, <a href="https://pubmed.ncbi.nlm.nih.gov/21878973/">not all make it to market</a>. </p>
<p>Some drugs are also “<a href="https://www.sciencedirect.com/science/article/pii/S2214716016301105">personalised</a>” so they are better targeted to an individual patient’s needs. This means small quantities of tailored drugs may be needed.</p>
<p>So organisations, such as drug manufacturers, wholesalers and hospitals, mainly rely on historical data to plan the production and distribution of medicines.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453714/original/file-20220323-17-12n9ysk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Blister packs of green capsules being made in a factory" src="https://images.theconversation.com/files/453714/original/file-20220323-17-12n9ysk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453714/original/file-20220323-17-12n9ysk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=341&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453714/original/file-20220323-17-12n9ysk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=341&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453714/original/file-20220323-17-12n9ysk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=341&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453714/original/file-20220323-17-12n9ysk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=429&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453714/original/file-20220323-17-12n9ysk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=429&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453714/original/file-20220323-17-12n9ysk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=429&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Until now, it’s been hard to predict which medicines need to be made and distributed to meet demand.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/green-capsule-medicine-pill-production-line-1845695305">Shutterstock</a></span>
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<p>However, Australia’s pharmaceutical supply chain is highly <a href="https://pubmed.ncbi.nlm.nih.gov/26244304/">fragmented</a>. There’s little coordination or data sharing among manufacturers, wholesalers and pharmacies. This leads to poor communication and incomplete or inaccurate information.</p>
<p>For instance, manufacturers may have little or no access to pharmacy data and stock levels. So, they cannot adequately plan for medicine production, which can take from several months to a year.</p>
<p>Australia also accounts for only <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202294/">2% of the world’s drug market</a>, a small one for
multinational pharmaceutical manufacturers. So their domestic suppliers generally keep a low stock due to short expiry dates and profit margins. </p>
<p>The slightest disruption, such as disease outbreaks or natural disasters, can easily spike demands and cause a shortage. Pandemic-related supply chain disruptions only make the existing challenges worse.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/supermarket-shortages-are-different-this-time-how-to-respond-and-avoid-panic-174529">Supermarket shortages are different this time: how to respond and avoid panic</a>
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<h2>What can we do about it?</h2>
<p>If a medicine is in short supply, there may be an alternative option a doctor can prescribe. But substituting medicines <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215837">can lead to</a> side effects, longer recovery times, longer stays in hospitals, and increased health-care costs. </p>
<p>Some pharmacies and wholesalers overstock their warehouses if they anticipate a shortage. But that is costly and medicines might expire before they are used. These are only short-term solutions.</p>
<p>So we need a system-wide and nationally coordinated approach among supply chain partners and the government to reduce the risk of medicine shortages.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/453557/original/file-20220322-24-18n7zya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453557/original/file-20220322-24-18n7zya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453557/original/file-20220322-24-18n7zya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453557/original/file-20220322-24-18n7zya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453557/original/file-20220322-24-18n7zya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453557/original/file-20220322-24-18n7zya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453557/original/file-20220322-24-18n7zya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Looking at vast amounts of data, from many sources, in real time is the key.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>We could do this using artificial intelligence technologies such as “<a href="https://www.sciencedirect.com/science/article/abs/pii/S1366554516303799?via%3Dihub">big data analytics</a>” and sharing data across the pharmaceutical supply chain. </p>
<p>Big data analytics can store and analyse a large array of data in different formats, from different sources, in real time. This would create an integrated database for all pharmaceutical supply-chain partners to have access to. This would allow all partners to monitor and predict demand in real time.</p>
<p>For example, a pharmacist would be able to access a centralised database on their computer and check the current stock level and availability of a medicine in other pharmacies, or even manufacturers and distributors. This could even help predict medicine shortages way before they occur. </p>
<p>For this to work, Australian pharmaceutical organisations need both robust IT and a skilled workforce that knows how to analyse and use the data. While this might be practical and affordable for pharmaceutical companies, this might not be the case for hospital or community pharmacies. </p>
<p>So governments would <a href="https://www.pc.gov.au/inquiries/completed/data-access/report/data-access.pdf">need to support</a> pharmacies and other smaller players – technically, financially, and with appropriate policies and regulations – to make sure they could access and use the data.</p>
<h2>We need to plan for the next crisis</h2>
<p>The current pandemic may be adding additional stresses to an already stretched supply chain. But future pandemics and natural disasters, such as floods and bushfires, will also worsen medicine shortages.</p>
<p>So we need to start planning now to create a resilient pharmaceutical supply chain that predicts medicine shortages and responds quickly.</p><img src="https://counter.theconversation.com/content/178608/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maryam Ziaee does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s easy to blame COVID. But Australia has suffered medicine shortages for years. The pandemic has only highlighted the problem. Here’s what we could do to better avoid shortages in the first place.Maryam Ziaee, Lecturer and Researcher, Supply Chains and Operations, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737992022-01-25T13:25:57Z2022-01-25T13:25:57ZOpioid overdose: A bioethicist explains why restricting supply may not be the right solution<figure><img src="https://images.theconversation.com/files/441839/original/file-20220120-9541-1nz1c60.jpg?ixlib=rb-1.1.0&rect=31%2C12%2C2085%2C1399&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What's the best way to solve America's opioid overdose crisis?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/macro-of-oxycodone-opioid-tablets-with-prescription-royalty-free-image/1162845770?adppopup=true">BackyardProduction/ iStock via Getty images</a></span></figcaption></figure><p>Year after year, America’s drug overdose crisis is worsening.</p>
<p>In the 12-month period ending in June 2021, the most recent period for which there is reliable data, <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm">more than 101,000 people died from drug overdose</a> in the U.S., – an increase of more than 20% from the previous year. </p>
<p>2021 was also an important year for analysis of the overdose crisis, with numerous books and articles shedding light on both the causes and potential solutions to the crisis.</p>
<p>Not all analysis is in agreement, however. As a <a href="https://www.travisrieder.com">bioethicist</a> who has spent much of the past several years researching the ethical and policy issues related to drug use, I’ve become particularly interested in an evolving tension between commentators on the drug crisis. </p>
<p>While many blame today’s crisis on <a href="https://doi.org/10.1093/qje/qjab043">an increase in drug supply</a> over the past 25 years, others suggest that increasing drug supply can <a href="https://doi.org/10.1503/cmaj.201618">actually be a solution</a>. So who is right? And what would ethical policy around drug supply look like? </p>
<h2>Access to drugs can be a problem</h2>
<p>The case against drugs is straightforward. As several experts have shown in recent years, the current drug overdose crisis was sparked by a steep increase in the supply of prescription opioids. </p>
<p>In his meticulously detailed book “<a href="https://www.penguinrandomhouse.com/books/612861/empire-of-pain-by-patrick-radden-keefe/">Empire of Pain</a>,” investigative journalist Patrick Radden Keefe reveals the extent to which Purdue Pharma, and the owning family, the Sacklers, utilized dishonest marketing strategies to drive aggressive prescribing of their extended-release opioid, OxyContin. Sales of the drug soared, and in the following years many <a href="https://www.nytimes.com/2019/08/27/health/johnson-and-johnson-opioids-oklahoma.html">other companies</a> followed similar playbooks.</p>
<p>Public health scientists have now shown that, starting in 1999, the volume of opioids prescribed and the overdose death rate from prescription opioids <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm">increased in parallel</a> for a decade, with prescription volume quadrupling by 2010 and overdose mortality quadrupling by 2008. </p>
<p>This is not the first time in American history that such a pattern occurred. As I argued in my 2019 book, “<a href="https://www.harpercollins.com/products/in-pain-travis-rieder?variant=32207679684642">In Pain</a>,” the prescription opioid problem of the early 2000s followed a pattern established by the development and marketing of morphine and heroin 100 years before.</p>
<p>When morphine was developed in the 19th century, its widespread use began to lead to addiction – especially among Civil War veterans. Historian <a href="https://vmi.academia.edu/JonathanJones">Jonathan Jones</a> has called this <a href="https://www.washingtonpost.com/history/2021/12/01/opioid-crisis-civil-war-addiction/">America’s first opioid crisis</a>. When heroin was developed by the Bayer AG company and marketed as a more potent, less addictive alternative to morphine that only <a href="https://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1953-01-01_2_page004.html">exacerbated the crisis</a>. </p>
<p>At least twice in recent history, then, increased access to opioids has resulted in significant public health harms. One could ask, if access to prescription opioids started the crisis, shouldn’t society work to restrict such access?</p>
<h2>Access to drugs isn’t America’s problem</h2>
<p>The problem with attempting to address overdose by restricting access to prescriptions is that the current drug overdose crisis is no longer a prescription opioid crisis. Although opioid prescribing has been dramatically curbed, overdose mortality has <a href="https://www.cdc.gov/opioids/basics/epidemic.html#three-waves">increased dramatically</a>.</p>
<p>Many overdose deaths in recent years have been <a href="https://www.cdc.gov/drugoverdose/deaths/other-drugs.html#anchor_1636146406061">polysubstance</a> deaths, involving multiple drugs. Most commonly, this includes illicit fentanyl, which is approximately <a href="https://www.cdc.gov/drugoverdose/deaths/other-drugs.html#anchor_1636146932580">50 times</a> more potent than heroin. Fentanyl and its chemical analogs – synthetic opioids that are designed to mimic the properties of fentanyl and can be even stronger – make the illicit drug supply unpredictable. When suppliers cut their drugs with varying amounts of fentanyl products, <a href="https://www.drugabuse.gov/publications/drugfacts/fentanyl">the potency differs dramatically</a>, making it difficult to dose. This unpredictability is <a href="https://www.cdc.gov/drugoverdose/featured-topics/overdose-prevention-campaigns.html">driving the striking increase</a> in accidental overdose being seen today.</p>
<p>In recognition of this fact, many scholars <a href="https://ycsg.yale.edu/sites/default/files/files/we_can%27t_go_cold_turkey.pdf">have argued</a> that policies focused on restricting drug access make the drug problem worse, not better. Making prescription opioids harder to get can <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1874575">push those with a use disorder</a> to the illicit market. And the illicit supply is unpredictable precisely because it is unregulated. Getting clean needles <a href="https://www.networkforphl.org/news-insights/ensuring-access-to-clean-needles-can-save-lives-but-legal-barriers-persist/">can be difficult</a> because of drug paraphernalia laws. And fear of arrest <a href="https://doi.org/10.1016/j.drugalcdep.2010.07.008">increases the risk of drug overdose</a> by leading people to use alone, or by making it risky to call for help if someone does witness an overdose. </p>
<p>In short: punitive drug policy makes using drugs more dangerous.</p>
<p>In her 2021 book “<a href="https://www.hachettego.com/titles/maia-szalavitz/undoing-drugs/9780738285757/">Undoing Drugs</a>,” journalist Maia Szalavitz shows that those advocating for harm reduction have long realized the negative effects of such policies, which is why they resist arguments that focus on restricting drug supply. Instead, they <a href="https://harmreduction.org/about-us/principles-of-harm-reduction/">argue for</a> policies that make using drugs safer.</p>
<p>These policies include <a href="https://www.cdc.gov/ssp/syringe-services-programs-summary.html">syringe exchange programs</a>, which reduce incidence of hepatitis and HIV among people who use drugs by reducing needle-sharing. Another example is distributing <a href="https://www.cdc.gov/stopoverdose/naloxone/index.html">naloxone, a medication that reverses opioid overdoses</a>. In addition, <a href="https://drugpolicy.org/issues/supervised-consumption-services">overdose prevention centers</a> – sometimes called safe injection sites or safe consumption sites – reduce the risk of drug-related harms by allowing people to use drugs in a sterile, supervised setting. </p>
<h2>Can drug supply be the solution?</h2>
<p>Some harm reduction advocates do not, however, stop at strategies to make using contaminated drugs safer. They argue for simply <a href="https://newrepublic.com/article/164531/overdose-deaths-safe-supply?utm_term=Autofeed&utm_campaign=EB_TNR&utm_medium=Social&utm_source=Twitter#Echobox=1638423476">giving people safer drugs</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman holding a bottle of pills in one hand and examining the contents in the palm of another hand." src="https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Should people have access to a regulated drug supply?</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sick-asian-young-lady-holding-pill-take-a-look-royalty-free-image/1320983152?adppopup=true">Tirachard/iStock via Getty Images.</a></span>
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<p>The “safe supply” movement, for example, <a href="https://time.com/6108812/drug-deaths-safe-supply-opioids/">claims that</a> an important way to reduce drug overdose is for people who use drugs to have access to pure, regulated forms that are easy to accurately dose. Although counterintuitive to those who think any drug use is bad, the logic is straightforward: Some people are going to use drugs regardless of how dangerous they are, so it’s better if the drugs they have access to are consistent in potency and so safer. </p>
<p>Taking this logic further yet, some scholars <a href="https://www.nbcnews.com/think/politics-policy/fentanyl-drug-overdose-deaths-are-rising-biden-administration-rcna6384">have argued</a> that because people should have access to a regulated drug supply, all drugs should be legalized. According to this view, since the unpredictability of the drug supply increases overdose risk, making the drug supply predictable should be part of the solution. </p>
<p>Advocates for both safe supply and legalization, then, hold that an increase in drug supply is not only not a problem – it could be a solution.</p>
<h2>Resolving the tension</h2>
<p>The key to resolving this tension is to recognize that drug supply can mean different things. An “increase in supply” can be both a problem and a solution.</p>
<p>The historical cases of morphine and heroin at the end of the 19th century, and then OxyContin a century later, suggest that increased access to badly regulated drugs can lead to harm. As <a href="https://doi.org/10.1080/15265161.2021.1891332">I have argued</a> in the American Journal of Bioethics, these cases pose a serious challenge to the argument for full legalization – especially if legalization implies that all drugs should be accessible to anyone over a certain age, as with alcohol or tobacco. The tension between those concerned about drug supply and those on the pro-legalization side may be unresolvable.</p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.]</p>
<p>Providing people who plan to use drugs with a safe supply, however, can be done without making drugs easily accessible to everyone; they just need to be easily accessible to that population. What the public health infrastructure needs is <a href="https://doi.org/10.1016/j.drugpo.2020.102769">a way to prescribe drugs to those committed to using</a> without thereby giving easy access to everyone. </p>
<p>While carefully regulated access to drugs can be harm reduction, unrestricted access can lead to harm expansion. The evidence on drug-related harms therefore supports a carefully regulated safe-supply policy in order to balance the risks and benefits of access to drugs.</p><img src="https://counter.theconversation.com/content/173799/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Travis N. Rieder does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Restricting drug access can make the overdose crisis worse, not better. A bioethicist explains what that means for an ethical drug policy.Travis N. Rieder, Director of the Master of Bioethics degree program at the Berman Institute of Bioethics, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1536282021-01-20T19:07:54Z2021-01-20T19:07:54ZI’ve heard COVID is leading to medicine shortages. What can I do if my medicine is out of stock?<figure><img src="https://images.theconversation.com/files/379646/original/file-20210120-15-1rkrr09.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C1000%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/middle-eastern-male-pharmacist-wearing-protective-1827869804">from www.shutterstock.com</a></span></figcaption></figure><p>You’ve just come from your monthly GP appointment with a new script for your ongoing medical condition. But your local pharmacy is out of stock of your usual medicine. Your condition is serious, and without it, your health is likely to suffer. What can you do?</p>
<p>While <a href="https://www.tga.gov.au/hubs/medicine-shortages">medicine shortages</a> happen from time to time, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235598/">researchers</a> and <a href="https://www.abc.net.au/news/2021-01-20/australia-post-coronavirus-medication-shortage/13065076">the media</a> report COVID-19 is causing more shortages than normal for many life-saving medicines. In Australia, <a href="https://www.abc.net.au/news/2021-01-20/australia-post-coronavirus-medication-shortage/13065076">media reports indicate</a> this includes some medications used to treat hyperthyroidism, high blood pressure, or allergies.</p>
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<p>Unfortunately, you’ll only likely find out if this applies to you when you reach the pharmacy. If that happens, there are a few ways you may be able to obtain your prescription.</p>
<p>But if the stock shortage will last for an extended period of time, and you cannot find a supply, your doctor may need to consider prescribing a different medication. </p>
<h2>Why are there shortages?</h2>
<p>Unfortunately, medicine shortages are an all too common problem of the modern health-care system. When our medicines come from a global supply chain — where raw ingredients are made in one country, processed into medicines in another, then freighted by sea or air to Australia — a single break in the supply chain can result in medicines going out of stock.</p>
<p>So there have been calls for Australia <a href="https://www.afr.com/politics/federal/australia-looks-to-boost-drug-manufacturing-20200413-p54je6">to set up its own medicines manufacturing base</a>. But even if we do, that doesn’t help now during COVID.</p>
<p>Medicines shortages is a <a href="https://www.who.int/medicines/publications/druginformation/WHO_DI_30-2_Medicines.pdf?ua=1">growing issue globally</a>. That’s because of increasing demand, higher quality standards and fewer manufacturing sites. </p>
<p>Shortages have also been exacerbated in 2020 due to COVID-19. When workers are <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30459-1/fulltext">locked out of the factory</a> because of a local outbreak, medicines don’t get made. And when we <a href="https://www.freightaustralia.gov.au/annual-report/the-year-that-was/covid-19-impacts-on-freight">restrict the number of flights into Australia</a>, that prevents medicines from arriving.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-law-wont-safeguard-medicine-supply-itll-only-ensure-we-know-theres-a-shortage-103100">New law won't safeguard medicine supply – it'll only ensure we know there's a shortage</a>
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</em>
</p>
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<p>When a manufacturer knows there is likely to be a medicine shortage, for any reason, they are required to inform the Australian Therapeutic Goods Administration (TGA) so pharmacies can make other arrangements, such as stocking up on alternatives or sourcing supply from other companies.</p>
<p>When the medicine shortage is considered to have a critical patient impact, or if it is in the interest of the public to know about the shortage, then the information is added to the TGA’s <a href="https://apps.tga.gov.au/prod/MSI/search">shortages website</a>, which the public can search.</p>
<p>But this information is only useful at the government and wholesaler level; local GPs and community pharmacists don’t have the time to check the site every day.</p>
<p>Dealing with shortages efficiently is important because their impacts are wide ranging. Shortages <a href="https://doi.org/10.1371/journal.pone.0215837">result in</a> higher costs to patients when they have to buy branded rather than generic formulations; more drug errors due to the different strengths and brands dispensed; more side-effects and higher death rates because of changes to less appropriate medicines; and more complaints from patients.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pharmacist taking medicine off shelf" src="https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There’s not always enough medicine to go round. And shortages can affect a patient’s health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-filling-prescription-pharmacy-drugstore-1281072733">www.shutterstock.com</a></span>
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<h2>What if your local pharmacy is out of stock?</h2>
<p>It is best to speak to your pharmacist about your options when your medication is out of stock. There may be other brands still available and appropriate to swap. Alternatively, your pharmacist could dispense a different strength of the same medication. <a href="https://www.psa.org.au/coronavirus/regulatory-changes/">Regulations</a> brought in during the pandemic have allowed pharmacists to do this to help with medicine supply. </p>
<p>If there are no appropriate substitutes, in rare instances a local compounding pharmacy can manufacture certain products in store.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-manage-your-essential-medicines-in-a-bushfire-or-other-emergency-127516">How to manage your essential medicines in a bushfire or other emergency</a>
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<p>If none of your local pharmacies stock your medicine, your next option is for an <a href="https://mymedkit.com.au/">Australian online pharmacy</a> to fill your script. It may be able to ship your medicine from another city or state.</p>
<p>It is not legal or safe for you personally to order prescription medications from online overseas suppliers. This is because they may not have been manufactured to Australian standards, and may be unsafe. But your pharmacist may do so on your behalf, under a special provision called <a href="https://www.tga.gov.au/ws-s19a-index">section 19A</a>.</p>
<p>If all else fails, you may need to contact your doctor about changing to a different medication. There are often many alternatives in the same drug class that work in the same, or very similar, way.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">Health Check: what should you do with your unused medicine?</a>
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</em>
</p>
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<p>Finally, and especially during COVID-19, for a large number of medicines pharmacists are only allowed to provide a <a href="https://www.tga.gov.au/media-release/limits-dispensing-and-sales-prescription-and-over-counter-medicines">maximum of one month’s supply</a> to each patient. </p>
<p>So if your medicine is actually in stock and you want extra, just in case, then by law they may not be able to dispense it to you. This is to prevent panic buying and to ensure the wider community has steady access to medicine; that is, to prevent further shortages.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-people-stockpiling-toilet-paper-we-asked-four-experts-132975">Why are people stockpiling toilet paper? We asked four experts</a>
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<img src="https://counter.theconversation.com/content/153628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is science director of the medicinal cannabis company Canngea Pty Ltd, a board member of the Australian Medicinal Cannabis Association, and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Elise Schubert is funded by a scholarship from the University of Sydney and Canngea Pty Ltd. </span></em></p>COVID-19 has resulted in higher than normal levels of medicine shortages. Here’s what to do if your local pharmacy is out of stock.Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyElise Schubert, Pharmacist and PhD Candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1349742020-03-30T17:32:20Z2020-03-30T17:32:20ZCanada’s coronavirus aid package guards against drug shortages with compulsory licensing<figure><img src="https://images.theconversation.com/files/323716/original/file-20200327-146671-lhxwq.jpg?ixlib=rb-1.1.0&rect=74%2C91%2C1842%2C1184&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The COVID-19 Emergency Response Act enables compulsory drug licensing to help avoid medication shortages.</span> <span class="attribution"><span class="source">(Pixabay)</span></span></figcaption></figure><p>Canada’s <a href="https://www.parl.ca/DocumentViewer/en/43-1/bill/C-13/third-reading">COVID-19 Emergency Response Act</a>, which provides emergency assistance to cope with the expected dramatic economic downturn due to the COVID-19 pandemic, contains an important clause that may get overlooked. The act effectively brings back compulsory licensing for drugs if supply is interrupted because of the effects of COVID-19. </p>
<p>There have already been stories about <a href="https://edmontonjournal.com/opinion/letters/wednesdays-letters-sellers-share-blame-for-toilet-paper-shortage/">toilet paper shortages</a> in parts of Canada. Far worse would be a shortage of medicines. That has already been reported in Australia where people are being accused of <a href="https://www.theguardian.com/world/2020/mar/19/paracetamol-and-ventolin-limited-to-one-per-customer-as-australia-combats-coronavirus-hoarding">hoarding Ventolin asthma puffers and acetaminophen</a>. Here in Canada, <a href="https://www.pharmacists.ca/news-events/news/canadian-pharmacists-association-warns-against-stockpiling-medication-in-response-to-covid-19/">pharmacists are already warning people</a> not to stock up on drugs as that may trigger shortages.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/323718/original/file-20200327-146724-1dayeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/323718/original/file-20200327-146724-1dayeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=426&fit=crop&dpr=1 600w, https://images.theconversation.com/files/323718/original/file-20200327-146724-1dayeg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=426&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/323718/original/file-20200327-146724-1dayeg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=426&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/323718/original/file-20200327-146724-1dayeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=535&fit=crop&dpr=1 754w, https://images.theconversation.com/files/323718/original/file-20200327-146724-1dayeg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=535&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/323718/original/file-20200327-146724-1dayeg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=535&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Stockpiling left toilet paper in short supply on March 19, 2020 at a Walmart in Laval, Que.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
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<p>Compulsory licensing helps prevent drug shortages. Simply put, compulsory licensing means that generic companies can get a licence to produce and market a drug even if the drug is still covered by a patent. In return the patent holder gets a royalty. Under the COVID-19 Emergency Response Act, the government can issue the licence almost immediately without having to first enter into negotiations with drug companies. The act doesn’t set out the amount of the royalty.</p>
<h2>Controlling high drug prices</h2>
<p>In 1969, in response to high drug prices in Canada due to the effects of the patent system, <a href="https://www.jstor.org/stable/45131117">Canada introduced legislation allowing compulsory licensing to import</a>. This meant generic companies could import and sell their own versions of drugs in Canada. Compulsory licensing proved to be an effective way to control drug spending.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/323717/original/file-20200327-146678-wzinzc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/323717/original/file-20200327-146678-wzinzc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/323717/original/file-20200327-146678-wzinzc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/323717/original/file-20200327-146678-wzinzc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/323717/original/file-20200327-146678-wzinzc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/323717/original/file-20200327-146678-wzinzc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/323717/original/file-20200327-146678-wzinzc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Stockpiling medications has led to shortage of Ventolin puffers for asthma in Australia.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
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<p>A <a href="http://epe.lac-bac.gc.ca/100/200/301/pco-bcp/commissions-ef/eastman1985-eng/eastman1985-eng.htm">1984 report</a> found that compulsory licensing had reduced the country’s annual drug bill by $211 million to a total of $1.6 billion, while at the same time brand-name drug companies lost only 3.1 per cent of the market. In fact, according to the report, since compulsory licensing started growth in the pharmaceutical industry was more buoyant in Canada than in the United States.</p>
<p>Despite its success, compulsory licensing was anathema to multinational pharmaceutical companies, especially those in the United States. Companies there influenced the American government to make the <a href="https://doi.org/10.2190/ucwg-ybr3-x3l0-nwyt">termination of compulsory licensing</a> one of the key conditions for successful negotiation of the 1987 Free Trade Agreement between Canada and the U.S. Brian Mulroney’s Conservative government complied with the U.S. demand and significantly weakened compulsory licensing, and then <a href="https://doi.org/10.1016/S0168-8510(96)00886-X">completely eliminated it following the completion of the NAFTA negotiations</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/323721/original/file-20200328-146699-ayvsl8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/323721/original/file-20200328-146699-ayvsl8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=767&fit=crop&dpr=1 600w, https://images.theconversation.com/files/323721/original/file-20200328-146699-ayvsl8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=767&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/323721/original/file-20200328-146699-ayvsl8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=767&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/323721/original/file-20200328-146699-ayvsl8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=964&fit=crop&dpr=1 754w, https://images.theconversation.com/files/323721/original/file-20200328-146699-ayvsl8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=964&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/323721/original/file-20200328-146699-ayvsl8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=964&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">An RCMP constable stands guard on Parliament Hill in Ottawa in October 2001 while hazardous materials personnel investigate a possible anthrax contamination.</span>
<span class="attribution"><span class="source">CP ARCHIVE PHOTO/Fred Chartrand</span></span>
</figcaption>
</figure>
<p>That was effectively the end of compulsory licensing as a means of dealing with both drug prices and shortages. Canadians briefly heard about compulsory licensing again <a href="https://www.npr.org/2011/02/15/93170200/timeline-how-the-anthrax-terror-unfolded">in the fall of 2001 when there was a scare about packages of anthrax being sent in the mail</a> to various people in the U.S. Ciprofloxacin was considered the best antibiotic for treating anthrax, but Bayer, the multinational that sold it, said that it couldn’t guarantee a sufficient supply if large numbers of people needed treatment. In return, <a href="https://www.theglobeandmail.com/news/national/patent-war-looming-over-drug-for-anthrax/article4155009/">Health Minister Alan Rock threatened to issue a compulsory licence</a>, but never followed through on the threat as the scare never materialized.</p>
<p>Compulsory licensing also played a role in the fall 2001 meeting of the World Trade Organization. Faced with the growing AIDS crisis and the then-unaffordable prices for HIV medicines, developing countries pushed the WTO to adopt a resolution allowing for the use of compulsory licensing to lower costs. The Doha Declaration applied to all countries, but <a href="http://www.who.int/medicines/areas/policy/WT_L_540_e.pdf?ua=1">Canada and a number of other developed countries pledged not to use compulsory licensing to import lower-priced drugs</a>.</p>
<h2>Rethinking future use</h2>
<p>That’s where compulsory licensing in Canada stood until last week. </p>
<p>Any compulsory licence issued under the COVID-19 Emergency Response Act is only good for one year, and no new licences will be issued after Sept. 30, 2020. The federal government should rethink those positions. </p>
<p><a href="https://www.canadadrugshortage.com/">Drug shortages in Canada have been around for a decade now</a> and they won’t go away once the COVID-19 emergency is over. Public drug spending <a href="https://www.cihi.ca/sites/default/files/document/pdex-report-2019-en-web.pdf">increased 6.8 per cent in 2018</a>, 1.5 percentage points higher than in the previous year. As we move to a national pharmacare plan we will need more ways to control drug prices and compulsory licensing could be one of those tools.</p>
<p>Let’s make compulsory licensing permanent.</p><img src="https://counter.theconversation.com/content/134974/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>In 2017-2020, Joel Lexchin received payment for being on a panel at the American Diabetes Association, for talks at the Toronto Reference Library, for writing a brief in an action for side effects of a drug for Michael F. Smith, Lawyer and a second brief on the role of promotion in generating prescriptions for Goodmans LLP and from the Canadian Institutes of Health Research for presenting at a workshop on conflict-of-interest in clinical practice guidelines. He is currently a member of research groups that are receiving money from the Canadian Institutes of Health Research and the Australian National Health and Medical Research Council. He is member of the Foundation Board of Health Action International and the Board of Canadian Doctors for Medicare. He receives royalties from University of Toronto Press and James Lorimer & Co. Ltd. for books he has written. </span></em></p>Toilet paper shortages were bad enough. A shortage of drugs during the COVID-19 pandemic would be worse. A provision in the Canadian government’s relief package aims to prevent that from happening.Joel Lexchin, Professor Emeritus of Health Policy and Management, York University, Emergency Physician at University Health Network, Associate Professor of Family and Community Medicine, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1218762019-08-25T19:53:47Z2019-08-25T19:53:47ZAfter 2 festival deaths, the NSW government rushed through a new drug homicide crime. But it may do more harm than good<figure><img src="https://images.theconversation.com/files/289167/original/file-20190823-170941-1hc4bap.jpg?ixlib=rb-1.1.0&rect=51%2C0%2C5760%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The first of its kind in Australia, the offence of 'drug supply causing death' carries a maximum 20 year sentence.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As the state election loomed last year, the NSW government rushed through a new crime targeting drug suppliers. A person who supplies a prohibited drug for profit can now be prosecuted for homicide if another person uses the drug and dies as a result. </p>
<p>The first of its kind in Australia, the <a href="http://www5.austlii.edu.au/au/legis/nsw/consol_act/ca190082/s25c.html">offence</a> of “drug supply causing death” carries a maximum 20 year sentence. The law was enacted after the deaths of 23-year-old Joshua Tam and 21-year-old Diana Nguyen at the Defqon.1 music festival in September, 2018. </p>
<p>In its haste to “do something” in response to their tragic deaths, the NSW government failed to consider harmful consequences that may arise from treating drug-related fatalities as homicide. In fact, <a href="https://www.academia.edu/40072032/Dancing_with_Death_Why_the_NSW_Homicide_Offence_of_Drug_Supply_Causing_Death_May_Cause_More_Harm_than_Good">my research</a> of how <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3265510">similar laws</a> have operated in the US suggests the new crime of “drug supply causing death” may <em>increase</em> the risk of fatal drug overdoses. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/289170/original/file-20190823-170931-1bdlsuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/289170/original/file-20190823-170931-1bdlsuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289170/original/file-20190823-170931-1bdlsuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289170/original/file-20190823-170931-1bdlsuo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289170/original/file-20190823-170931-1bdlsuo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289170/original/file-20190823-170931-1bdlsuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289170/original/file-20190823-170931-1bdlsuo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289170/original/file-20190823-170931-1bdlsuo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Two deaths at the DEFQON.1 music festival led the NSW government to rush through the new crime of ‘drug supply causing death’.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/hanuska/37127862472/in/photolist-YyRZZS-YxgkwN-YdYvUs-YBvHJg-Yxh7jy-Yxh9Tb-YdZ6nu-YBvE4F-YySLY9-Xy8in3-YdZ9GL-YBvi5B-YQd1nP-Xy8g33-Xy9gJm-XAcQq4-YdYNL3-XAdowP-cpN1uJ-2f37sod-byMf45-byMfny-bMFVHt-bMFW2k-bMFUtV-9Xv6dE-2a3J7Tm-YxgwxL-bMFVcB-bMFYkH-byMkbS-bMFUBH-W6wJ8G-6q2PsN-nmhdgr-2b98FuB-njvGsK-28ofGx3-2a3J5qW-njvGDM-2b98Gpx-nhtgMu-nmhfSP-njxZdd-2a3J7jL-njxYDY-nhthKG-njvH7k-njeiWG-njxV3j">Dushan Hanuska/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<h2>An unprincipled approach</h2>
<p>Just three days after the festival deaths, NSW Premier Gladys Berejiklian commissioned a panel comprising three heads of government agencies to advise whether “new offences or increased penalties were needed to stop drug dealers endangering lives”. </p>
<p>The panel was directed <a href="https://www.liquorandgaming.nsw.gov.au/__data/assets/pdf_file/0004/209965/Keepingpeoplesafe.pdf">not to consider pill testing</a>, consistent with the government’s “zero tolerance” approach to illicit drug use.</p>
<p>And the <a href="https://static.nsw.gov.au/1540188213/Keepingpeoplesafe.pdf">panel</a> warned “more analysis and consultation” was needed before enacting the offence, given the “legal complexities” involved. </p>
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Read more:
<a href="https://theconversation.com/testing-festival-goers-pills-isnt-the-only-way-to-reduce-overdoses-heres-what-else-works-118827">Testing festival goers' pills isn't the only way to reduce overdoses. Here's what else works</a>
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<p>But the government ignored this advice. Without any known consultation with criminal law experts or the NSW Law Reform Commission, it hastily enacted the offence of “drug supply causing death” in November last year.</p>
<h2>The crime of ‘drug supply causing death’</h2>
<p>Like the <a href="https://criminalcpd.net.au/wp-content/uploads/2016/09/JQ_Article_OnePunch_Laws_Mandatory_Minimumus_as_Published_1_April1.pdf">controversial</a> “one-punch” homicide offence introduced in 2014, the new drug homicide offence is an attempt to quickly “fix” a complex public health problem. </p>
<p>The offence is in <a href="https://www.legislation.nsw.gov.au/#/view/act/1900/40/part3/div1/sec25c">section 25C</a> of the Crimes Act 1900, and says the supply must be for “financial or material gain”, as opposed to what Attorney-General Mark Speakman called the <a href="https://www.parliament.nsw.gov.au/Hansard/Pages/HansardResult.aspx#/docid/HANSARD-1323879322-104603">“young friends” scenario</a>. In other words, people who pass on drugs to their friends without making a profit shouldn’t be prosecuted for this offence (but may be liable for <a href="http://www8.austlii.edu.au/cgi-bin/viewdb/au/legis/nsw/consol_act/dmata1985256/">other</a> drug supply offences).</p>
<p>The legislation was drafted before the government could consider the recommendations of the NSW coronial inquest into the drug-related deaths of six young people at music festivals. The coroner is <a href="https://www.abc.net.au/news/2019-07-20/music-festival-drug-inquest-wrap/11326050">expected</a> to hand down her findings in October. </p>
<p>The music festival deaths have been linked to ecstasy (MDMA) use. However, section 25C targets drugs beyond ecstasy and contexts beyond music festivals. It extends to the supply of <em>any</em> <a href="https://www.legislation.nsw.gov.au/#/view/act/1985/226/sch1">prohibited drug</a> (except cannabis) including crystal methamphetamine (ice), cocaine and opioids such as heroin. </p>
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Read more:
<a href="https://theconversation.com/law-and-order-is-no-get-out-of-jail-card-for-floundering-politicians-107701">Law and order is no get-out-of-jail card for floundering politicians</a>
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<p>On the other hand, if a person supplies another person a legal — albeit potentially harmful — drug, such as alcohol or tobacco, and the user dies from ingesting or inhaling that drug, the supplier cannot be prosecuted under section 25C. </p>
<h2>New crime may do more harm than good</h2>
<p>Similar drug-induced homicide laws in the US, which have existed since the 1980s, show how the NSW crime might exacerbate, rather than prevent, drug-related harms. </p>
<p>In many US states, drug suppliers are zealously prosecuted for homicide, with police opting to pursue low-level dealers as opposed to major traffickers. </p>
<p>Charges are <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3265510">disproportionately</a> laid against people of colour in cases involving white victims. People of colour also serve longer sentences for these offences than white defendants.</p>
<p>Disturbingly, evidence from the US <a href="https://theappeal.org/charging-dealers-with-homicide-explained/">suggests</a> drug homicide offences <em>increase</em> the risk of death to drug users. Faced with the prospect of prosecution and a lengthy prison sentence, suppliers and bystanders are more likely to abandon people experiencing drug overdose symptoms than seek medical help. </p>
<p>The NSW parliament could have, but did not, enact a “Good Samaritan” immunity alongside the crime of drug supply causing death. This immunity would allow dealers to avoid prosecution for homicide when they immediately seek medical help for users showing signs of distress.</p>
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Read more:
<a href="https://theconversation.com/unlawful-strip-searches-are-on-the-rise-in-nsw-and-police-arent-being-held-accountable-121986">Unlawful strip searches are on the rise in NSW and police aren’t being held accountable</a>
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<h2>Independently-made choices</h2>
<p>Section 25C is a radical departure from NSW homicide law. For the crimes of murder and manslaughter, the prosecution must establish a <a href="http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/HCA/1991/27.html?context=1;query=Royall%20;mask_path=">causal link</a> between the defendant’s actions and the victim’s death. </p>
<p>Applying established rules of causation, in 2012, the High Court <a href="http://eresources.hcourt.gov.au/showCase/2012/HCA/35">held</a> that a methadone supplier was not criminally responsible for the death of the person who self-administered the methadone. The High Court reasoned that the voluntary and informed decision of an adult to take a prohibited drug broke the “chain of causation” between supply and death.</p>
<p>Section 25C departs from the <a href="https://books.google.com.au/books?id=wTa8AQAAQBAJ&dq=JS+Mills+harm&source=gbs_navlinks_s">libertarian</a> principle that individuals are responsible for independently-made choices that may bring about harm to themselves. </p>
<p>For the crime of drug supply causing death, a “causal link” need only be established between the <em>drug user’s</em> action in taking the drug and their death. As a result, a person might be prosecuted for drug supply causing death when: </p>
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<li>a person overdoses on drugs to intentionally end their own life </li>
<li>a person drives under the influence of drugs, crashes their vehicle and dies</li>
<li>a person loses their inhibitions from taking drugs, jumps off a bridge and dies. </li>
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<p>These are just some of the unintended consequences that may arise from the failure to subject this law to <a href="http://www.austlii.edu.au/au/journals/CICrimJust/2015/9.html">rigorous scrutiny</a>. </p>
<h2>Assessing risk of death</h2>
<p>One aspect of the offence that is <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=326551">narrower</a> than its US counterparts is the “mental” element. The prosecution must prove the person who supplied the drug knew, or should reasonably have known, the drug supply would expose another person to a “significant risk of death”. </p>
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Read more:
<a href="https://theconversation.com/how-hard-is-it-to-say-no-to-drugs-111536">How hard is it to say 'no' to drugs?</a>
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<p>Assessing whether a risk of <em>death</em> is <em>significant</em> will be no easy task, and will depend on the unique facts of each case. <a href="https://theconversation.com/how-does-mdma-kill-109506">Variables</a> include whether the accused knew, or should have known, about the quantity, strength and toxicity of the drug; whether the drug was consumed with other drugs including alcohol; environmental factors; and the user’s health. </p>
<p>What’s clear is this punitive criminal law response to a serious public health problem, without adequate consultation or evidence, will produce unintended consequences. Failing to learn from the US experience, the new offence of drug supply causing death is likely to result in more harm than good.</p><img src="https://counter.theconversation.com/content/121876/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elyse Methven does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Similar laws in the US have actually led to increasing the risk of fatal drug overdoses.Elyse Methven, Lecturer in Law, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.