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Access · Shortages · continued

Second pass at: Hoarding and why it makes a shortage worse posts 91–120

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

IB
i.boatengTL212 Oct 2024#91

Where an alternative within the class is available, the comparison is a clinical one and the doses are not equivalent.

20 likes 22mo
SB
sharps_binTL2Regular12 Oct 2024#92

Where I part company with post #88, and it is a narrow parting.

Both are useful and different. The notice tells you the national position; the account tells you what is happening on the ground.

That has been true for the cases I have seen and I have not seen many.

0 likes 22mo
SO
se.okaforTL212 Oct 2024#93

Pharmacy-level availability varies enormously during a shortage, so two honest accounts from the same city can be opposite.

I am confident about the direction and much less about the magnitude.

2 likes 22mo
OF
outline_firstTL3Wiki editor12 Oct 2024#94
r.ekstrom, post #27: Reports that a pharmacy has stock are the least durable information on the site and are still worth posting with a date. Go to post

Switching presentation or strength during a shortage is a prescribing decision rather than a substitution anybody should improvise.

8 likes in reply to #27 22mo
BK
b.kowalskiTL212 Oct 2024#95

Stockpiling in response to a shortage worsens it, which is true and is a poor argument to make to somebody who has run out.

27 likes 22mo
EF
e.ferreiraTL3Regular12 Oct 2024#96

Shortage-driven price movement is real and is a separate question from availability.

0 likes 22mo
HF
h.falkTL212 Oct 2024#97

Narrowing post #94, because the general version has more than one answer.

Anyone reporting availability should say the region and the date, because both determine whether the report is usable.

This is the version I would want a new member to read first.

4 likes 22mo
TD
titration_diaryTL3Regular12 Oct 2024 · edited#98
t.dumitru, post #18: Quietly grateful for the plain phrasing. Not every thread gets that. Go to post

Noted, and I have changed what I was going to do on the strength of it.

13 likes in reply to #18 21mo
PF
p.fontaineTL212 Oct 2024#99

The published shortage register maintained by the national regulator is the authoritative source here, and it is updated far more often than any thread.

That is the practical version. The rigorous version is longer and says the same thing.

9 likes 21mo
NR
n.rowntreeTL3Regular12 Oct 2024#100

Shortage status determines what compounding is permitted in some jurisdictions, which links two questions that otherwise seem unrelated.

21 likes 21mo
VS
v.sjobergTL213 Oct 2024#101

Managing an unplanned gap: if a shortage causes a gap in treatment, the questions are how long the gap will be and how that affects your condition. Discussing with your clinician is prudent if the gap is weeks or longer.

I would not lead a decision with this, but I would not ignore it either.

6 likes 21mo
TV
t.vasquezTL4 Moderator13 Oct 2024#102
z.adeyemi, post #83: Right — I had this wrong and I am glad to have read it before it mattered. Go to post

Saving this. It is the version I will quote when the question comes round again.

16 likes in reply to #83 21mo
NL
n.laurentTL213 Oct 2024#103
a.wikstrom, post #16: Where an alternative within the class is available, the comparison is a clinical one and the doses are not equivalent. The evidence for this is thinner than the way I have phrased it suggests. Go to post

Where a shortage forces a gap, the pharmacokinetics mean a missed week is a perturbation rather than a reset, which is worth knowing.

Happy to be corrected if someone holds better data than mine.

32 likes in reply to #16 21mo
CR
compounding_ruthTL4Pharmacist13 Oct 2024#104

I had written a reply contradicting post #103 and deleted it. Here is what survived.

Compounding during shortages: some jurisdictions allow pharmacy compounding when a marketed product is in shortage. That permission is jurisdiction-specific and time-limited (usually for the duration of the shortage).

0 likes 21mo
NP
n.petrovTL213 Oct 2024#105

This follows post #104 rather than contradicting it.

A shortage of one presentation is not a shortage of all of them, and the published notices are specific about which.

10 likes 21mo
BN
b.nilsenTL213 Oct 2024#106
c.castellanos, post #76: On post #74 — agreed on the reasoning, with one qualification. Both are useful and different. The notice tells you the national position; the account tells you what is happening on the ground. Noting that the question and the thing people usually mean by it are different. Go to post

Manufacturer allocation decisions during a shortage are commercial and are rarely explained, which is frustrating and is not evidence of anything.

Two sources, same conclusion, and I could not rule out that one copied the other.

23 likes in reply to #76 21mo
MR
m.rasmussenTL213 Oct 2024 · edited#107

Reports that a pharmacy has stock are the least durable information on the site and are still worth posting with a date.

It cost nothing to check and would have cost something not to.

0 likes 21mo
ZO
z.onwukaTL213 Oct 2024#108

Dose hold versus tapering: if a temporary shortage forces a gap, holding your dose and resuming when supply returns is different from gradually tapering. The two are different decisions.

This is the sort of thing that ought to be settled and apparently is not.

1 like 21mo
MS
m.steinerTL213 Oct 2024#109
h.jansen, post #87: Planning around a known shortage window is easier than reacting to one, and the notices give advance warning more often than people expect. Go to post

The arithmetic in post #108 is right; the assumption feeding it is the part to check.

Shortage predictions: regulators and suppliers issue shortage alerts before they become acute. Checking the regulatory website for shortages gives you advance notice.

16 likes in reply to #87 21mo
B
batchlogTL3Regular13 Oct 2024#110
c.niemel, post #4: Taking the opening post at face value and following it one step further. Regional differences during a shortage are large, and a supply position in one country says nothing about another. I would want a second opinion before relying on that. Go to post

Answering the question post #106 raises rather than the one it answers.

International supply chains: a shortage in one country does not mean shortage in another. That is why ordering from multiple suppliers before a shortage gets bad is prudent if you can.

31 likes in reply to #4 21mo
BD
baseline_driftTL2Analytical chemist13 Oct 2024#111
TL4_Halvorsen, post #13: Post #10 is the version of this I will quote in future. One addition. Compounding during shortages: some jurisdictions allow pharmacy compounding when a marketed product is in shortage. That permission is jurisdiction-specific and time-limited (usually for the duration of the shortage). Small point, but it is the one that usually… Go to post

Shortage-driven price movement is real and is a separate question from availability.

It is worth checking rather than assuming, which costs nothing.

3 likes in reply to #13 21mo
NK
n.krastevTL213 Oct 2024 · edited#112

Pharmacy-level availability varies enormously during a shortage, so two honest accounts from the same city can be opposite.

Reading it again, the caveat matters more than the finding.

0 likes 21mo
DO
d.oyelaranTL3Pharmacist13 Oct 2024#113

Everything in post #109 holds. The case it does not cover is the one I have.

Anyone reporting availability should say the region and the date, because both determine whether the report is usable.

30 likes 21mo
CT
c.tullochTL213 Oct 2024#114

Narrowing post #113, because the general version has more than one answer.

Both are useful and different. The notice tells you the national position; the account tells you what is happening on the ground.

15 likes 21mo
K
KLindqvistTL4 Moderator13 Oct 2024#115
ms_holloway, post #26: Fair, and the limits you put on it are the part I will remember. Go to post

Reports that a pharmacy has stock are the least durable information on the site and are still worth posting with a date.

6 likes in reply to #26 21mo
FK
f.kimaniTL213 Oct 2024#116

This follows post #113 rather than contradicting it.

Where an alternative within the class is available, the comparison is a clinical one and the doses are not equivalent.

1 like 21mo
LW
l.wikstromTL213 Oct 2024#117

Helpful, and short, which on this subject is harder than long.

0 likes 21mo
VN
v.nascimentoTL213 Oct 2024#118

Stockpiling in response to a shortage worsens it, which is true and is a poor argument to make to somebody who has run out.

This has been discussed before and I could not find the thread, so, again.

21 likes 21mo
VD
vial_deskTL3Regular13 Oct 2024#119
s.chowdhury, post #39: Regional differences during a shortage are large, and a supply position in one country says nothing about another. Worth saying I have only my own numbers here, and n is small. Go to post

On post #118 — agreed on the reasoning, with one qualification.

Dose hold versus tapering: if a temporary shortage forces a gap, holding your dose and resuming when supply returns is different from gradually tapering. The two are different decisions.

9 likes in reply to #39 21mo
AE
a.eriksenTL213 Oct 2024#120