Page 66 - Retail Pharmacy Magazine October 2020

64 HEALTH BONES AND JOINTS FROM PAGE 63 issues for people with autoimmune conditions, such as rheumatoid arthritis and lupus, who needed the drug, which generated quite some stress,” Ms Marine said. “Stories abounded of some people visiting up to 15 pharmacies to obtain the drug, to no avail. “The situation was exacerbated in that the drugs patients take for these conditions are immunosuppressive, so people were already concerned that they were at greater risk of contracting the coronavirus due to compromised immune systems.” Hydroxychloroquine versus virus Pharmacists should be aware that there is little evidence that hydroxychloroquine (or chloroquine) safeguards against Covid-19. This is according to three randomised controlled trials of hydroxychloroquine that have not proven or disproved a beneficial or harmful effect on Covid-19 clinical course or clearance of the virus. However, Ms Marine says access to hydroxychloroquine has since improved. “The government, working with a range of stakeholders, introduced measures at the supplier and pharmacy wholesaler level to address the problem,” she said. Limits were put on prescribing, with only specialists having the mandate to initiate new scripts for hydroxychloroquine and other in- demand drugs, as well as a month’s supply restriction on drug purchasing. The importance of drugs being available for those living with rheumatoid arthritis (RA) should not be underestimated, considering it affects 458,000 Australians (1.9 per cent of the population). Arthritis and musculoskeletal problems accounted for 13 per cent of the total burden of disease in 2015, and in 2016- 17 there were 13,213 hospitalisations for RA, a rate of 54 per 100,000 population. In 2015-16, these conditions cost the Australian health system an estimated $12 billion, representing 9.6 per cent of total disease expenditure. Stigma of opioid use problematic Another problem of drug availability has been restrictions on access to opioids, given that arthritis in general, including RA and osteoarthritis, has been among the leading conditions for which opioids have been prescribed and used, Ms Marine says. The pain of RA is well known. In 2017- 2018, 68 per cent of surveyed people with RA experienced ‘moderate’ to ‘very severe’ pain in the four weeks before being interviewed. People with RA were 30 per cent more likely to have had severe or very severe bodily pain in the previous four weeks compared with those without the condition at 10 per cent. This makes it unsurprising that opioids are often prescribed for the condition, characterised as it is by pain and functional limitations occurring soon after the onset of the disease and worsening with time. Joint damage in the wrist is reported as the cause of most severe limitation, even in the early stages of RA. When it comes to osteoarthritis and backache, Ms Marine highlights that the evidence suggests opioids are of limited benefit, which itself is likely to be outweighed by the potential harms of the drug. “In fact, the Royal Australian College of General Practitioners’ guidelines on osteoarthritis don’t recommend opioids at all,” she said. “And yes, there’s been a lot of concern as to how patients have been taken off opioids, with some complaining that they’ve been stigmatised and made to feel like criminals for asking for pain relief. “However, opioids can be an important part of a pain management plan for many people, and it’s vital that people can still access these products if necessary.” “Joint damage in the wrist is reported as the cause of most severe limitation, even in the early stages of RA.” RETAIL PHARMACY • OCT 2020