On The Docket
David B. Brushwood, BSPharm, JD
Drug shortages are an unfortunate reality of contemporary pharmacy practice. Caring pharmacists and pharmacy technicians solve problems caused by drug shortages on a daily basis. They understand that the failure to provide medications to patients can lead to harmful medical outcomes. A recent legal case from Oregon describes how drug shortages can lead to harmful familial outcomes as well.
Background
A ten-year-old child had been prescribed amphetamine/dextroamphetamine for 3 years to treat behavioral issues. The medication was effective. In October 2022, he received a new prescription for a continuing supply of the medication. His mother was told by the family’s pharmacy that the drug was unavailable. The mother was not told that other pharmacies might have the medication or that the prescriber might be able to authorize an alternative medication.
As a result of medication deprivation, the child’s behavior escalated to the point that on one occasion he physically lashed out at teachers and school staff while kicking doors and screaming. The principal called law enforcement later in the day after the child continued to beat on doors, scream, and refuse to listen to school staff. The child was suspended and later expelled.
A government agency removed the child from the mother’s custody after concluding that the mother was “unable to meet the child’s medical and safety needs” and that the mother lacked “the parenting skills necessary to safely parent the child.” The juvenile court upheld the agency action, and the mother appealed.
Rationale
The appellate court quoted the juvenile court’s ruling that the mother “struggled to connect the dots and put the pieces together and to function in the parental role to make sure that the child’s medical needs are taken care of.”
The appellate court noted that during the juvenile court hearing, the mother learned for the first time that the medication could have been obtained at a different pharmacy.
At the time of the appeal, the child was doing well in a different school that assisted in administering the child’s medication. The child’s medical clinic promised to help locate the medication if the mother had difficulty obtaining the child’s medication.
The appellate court said, “The record supports the inference that, in the midst of an extraordinary challenging confluence of events, mother failed to meet the child’s needs on that occasion.” The court concluded that, “Many families have unexpected circumstances they do not plan for. Many do not respond optimally. But the law does not allow for dependency jurisdiction based on parenting mistakes that do not result in ongoing risk of serious loss or harm.”
The ruling of the juvenile court was reversed, and the child was returned to his mother’s custody.
Takeaways
At a time when commodities such as toilet paper, sanitary wipes, and disinfectants are in short supply, or are unavailable, people may become resigned to the inevitability of doing without ordinary necessities. They may not understand that drug shortages require special efforts to obtain needed medications. Giving up is not acceptable.
Pharmacies can’t magically make drugs appear when they are unavailable due to shortages. But pharmacies can help patients and parents figure out how to effectively deal with drug shortages. At a minimum, consider these steps:
- Be mindful of the serious consequences of medication deprivation.
- Appreciate that some people don’t understand the complexities of the health care system. Show them how to connect the dots and put the pieces together.
- Explain to the patient or the patient’s representative the potential consequences of failing to use a prescribed medication.
- Identify other possible sources of the medication for the patient.
- Consult with the prescriber to determine whether an alternative medication might be effective over a brief period of time until the preferred medication is in stock.
- Do not allow the patient to simply walk away with no plan for managing the challenge presented by a medication shortage. ■