I’m Stuart Gale, a third generation pharmacist. I run three bricks and mortar chemists in Oxford as well as www.oxfordonlinepharmacy.co.uk. Having been involved with pharmacy, in one way or another, since I was a child. During this time, I have seen huge change - some good, some less so. Now, with Brexit on the horizon, I know people are worried about the impact it might have on their access to medication, and what they can do about it. I am here to share any insight I might have so: Ask Me Anything!

Comments: 425 • Responses: 64  • Date: 

StuartGale151 karma

I think that there are lots of issues with the supply chain. It isn’t as robust as it used to be. Suppliers seem to operate on a just in time basis. The minute there is a problem we all run out. I think Brexit will make it worse but there has been a lot of planning. Best to be organised and not leave it to the last minute. But no stockpiling.

mimacat133 karma

I'm in Belfast and I've noticed a lot of my lupus friends here are having a panic about what it means for us. We've already noticed that there are certain brands of hydroxy chloroquine we can't get and I know that there's fears over particular prednisone and nifedipine as well.

Have you heard any advice for over here specifically? Or is it time to have a proper discussion with my absolute legend of a wonderful pharmacist who has saved my ass many times?

And seriously, you guys are unsung heroes. Thank you.

StuartGale107 karma

I think talk to your local pharmacy - there will be different issues. Main advice - don't leave it to the last minute.

vwlsmssng67 karma

The NHS publish some information about shortages here:

https://www.sps.nhs.uk/category/shortages-discontinuations-and-expiries/shortages/

and information about continuity of supply here:

https://www.england.nhs.uk/eu-exit/medicines/ (FAQ)

What other reliable sources of information are there?

StuartGale40 karma

I think they are good links.

https://www.mims.co.uk/drug-shortages-live-tracker/article/1581516

You can use this one but subscription required

thelazydiarist65 karma

What medications are most likely to be hard to find immediately after Brexit?

StuartGale150 karma

We are already seeing problems across the board. HRT is difficult in particular. I gather there has been a lot of insulin fridge storage prepared in advance which should help. My advice is not to panic and stockpile. If we do that there will be big problems, just don't leave it to the last minute to get your prescriptions. Reorder at least 7-10 days in advance and accept some things may need to be changed.

mronion8253 karma

My surgery is being very strict with reissueing- there's no opportunity to stockpile. And frankly, if I run out of quetiapine, things will look very bleak.

Enemyonwheels36 karma

Running out of Quetiapine would be very bad. Even forgetting ONE is bad enough.

StuartGale23 karma

Supplies look ok at the moment

StuartyG1141 karma

Would Brexit lead to a shortage of some anti depressants? Fluoxetine, sertriline, Vensir XL etc

StuartGale49 karma

We hope not. But that's the thing with Brexit. Nobody knows. Don't panic - order in time and be prepared to change medication or brand if you have to

StuartyG117 karma

Thank you, I may be coming off mine in a couple of weeks, but if my body can't handle it I will go back on them, I don't fancy not being able to handle the withdrawal etc

StuartGale9 karma

good luck

FlashyBalance-7 karma

so far all your replies have been "I think" and "I don't know" and you claim to be an expert

StuartGale10 karma

I'm sorry - you are all asking about individual medicines. It is very hard for us to know and changes on a daily basis. I can tell you all about availability today. Sorry to disappoint you. It's hard for us all.

Jamrolled35 karma

I read a few of your answers. Seems like all you can say is no one really knows/ check with your pharmacist.

I’d been trying to get an appointment at my local doctors for over a month. Gave up weeks ago. You suggest not stockpiling, but in areas like mine getting an appointment can take weeks of waking up before 8 to get on the phone. If we don’t stockpile when we can get an appointment, we could be waiting weeks before we’re seen again. How can more uncertainty do anything but further disrupt our NHS?

Can you pinpoint any direct effects on pharmaceuticals/NHS? Good or bad?

My main question would be, do you think brexit will hit poorer communities like mine the hardest? Can’t imagine the people of oxford will be all that bothered compared to Toxteth.

StuartGale24 karma

I am sorry - but as with most Brexit issues we don't know what is going to happen and I genuinely don't think anyone does. WE have been battling supply issues for years on the back of crippling funding cuts to pharmacies in the UK. Businesses like mine are doing their very best to keep customers happy and healthy. It's not easy. If all the UK customers stockpiled medicines the whole country would run out in a very short time. Its far from ideal but the best thing to do is work with your local pharmacy and GP.

DarlingBri23 karma

Can you talk more about why there is already an HRT shortage when Brexit hasn't even happened yet, and the outlook for HRT?

(Full transparency: I mod the menopause sub r/TrollXMenopause so I have a special interest.)

manicleek15 karma

If it's like many other industries, it may be due to suppliers being unwilling to make deals that span a time frame that crosses the date Brexit is supposed to take place.

StuartGale14 karma

I think the supply chain is fragile. One brand goes short because of a change of ownership and the demand goes onto another brand. They are not prepared for increased sales , so they go out of stock too. Like a pack of cards. There are alternatives like oestrogen gels instead of patches. Speak to you local pharmacy or someone at oxfordonlinepharmacy.co.uk

francesrainbow20 karma

As far as you know are there expected to be differences in patients' experiences in the devolved nations compared with England? (Asking from Scotland)

Also - any specific issues regarding mental health medications? We often seem to have difficulties unrelated to Brexit (e.g. Fluphenazine being discontinued recently) and I wonder how Brexit will affect this specific branch of medicine (psychiatry).

Thank you for your opinion!

StuartGale10 karma

I don't think so - but will be down to local wholesale stocks. Its very hard to know what will happen

francesrainbow6 karma

That's fair. As this is an AMA, do you mind me asking about your political views and whether you would consider yourself a supporter of the Conservative Party?

StuartGale19 karma

I just don't want change to make it harder. Not sure anyone would make a good job of this

fivetenfiftyfold11 karma

What is the situation with Gabapentin and Amytriptiline looking like? My husband is deathly worried about not being able to get his pain medication? What about lidocaine patches?

StuartGale15 karma

There do seem to be shortages of gabapentin - amitriptyline seems ok at the moment. The brand or gabapentin (Neurontin) is available too

nickname_esco10 karma

By what mechanism will a shortage be caused by?

Is it that most of the medicines come from european warehouses and the border blockage will lead to nothing/less coming in and then british warehouses being depleted very quickly?

StuartGale16 karma

I think that it will all slow down. Wholesalers have been instructed to carry more stock so hopefully that will soften the blow

amethnitrate8 karma

I work for pharma manufacturing. Do you have any insight on reglatory compliance from a pharmacy point of view? We're exact opposites ends of the supply chain. My interpretation was that no deal means the recognition between the EU and is potentially dissolved and therefore we lose the official Quality assurance aspect. Taking a lot of work to rejig the supply agreements etc.

StuartGale3 karma

Agreed this could be a nightmare. I'm sure some thing will be arranged swiftly on this.

trippy7417 karma

Will Brexit affect medicine that is necessary to certain people?

StuartGale7 karma

I think the market is difficult anyway. Brexit won't make it better! Speak to your local pharmacist early to see what the situation is like in your area.

fred_lincoln7 karma

I'm an American. I have an elderly friend who regularly gets drugs shipped to her from a UK pharmacy (sorry, don't know what the drugs are, but she has a lot of heart and kidney issues). Apparently it's much MUCH cheaper that way. Will Brexit affect overseas shipments of drugs in situations like this?

StuartGale4 karma

I don't think it will as long as they are available

kanman2917 karma

Are there likely to be shortages of hospital medications (e.g. saline bags)similar to what happened in wake of hurricane Maria in the US?

StuartGale6 karma

not sure about hospitals - they will have done a lot of planning though

garrett_k6 karma

My understanding is that pharmacists over there are referred to as chemists. Are you trained/capable/allowed to synthesis medications in your own shop from precursor ingredients (more than just compounding)? Or is this just a vestigial name?

StuartGale9 karma

Not practical in the UK now.

mrdougan5 karma

Any reports of potential shortage in thyroxine / anti-migraine meds ?

StuartGale6 karma

Thyroxine seems ok. Migraine treatments do seem short in supply

beeniebobs5 karma

I'm a chronic pain patient with multiple conditions at chronic levels. I have been on the fentanyl patches since 2014. Is there a chance of my medication being difficult to obtain and if so what can I do and what medication could I take to combat a fentanyl withdrawal? I did attempt to stop taking fentanyl at one point and withdrawal was horrendous and the only support I got from gp was to keep using the patch.

StuartGale4 karma

There are lots of options with fentanyl - hopefully you will be ok - you might have to change brand or method of administration though.

Captainpanda554 karma

Do you feel that enough is being done to prevent deaths as a result of drug supply (or lack thereof)?

StuartGale9 karma

No I don't think so - we are all in the dark

skipsaur4 karma

Hi, disclaimer: I'm from the US so I'm used to a large amount of profiteering in our health system, not sure if this question is applicable in the UK:

Have you seen/do you anticipate any price increases from your wholesalers in response to shortages? If so, are you concerned at all about your businesses' ability to absorb/adjust to any fluctuations?

Is it legal currently for British citizens to purchase medication from other countries within the E.U.? If so, will Brexit have any effect/prohibit this, or is it an option if there are shortages in the UK and people are desperate/don't really have treatment-switching options? ("Medical tourism" is a big thing in the US, when a plane ticket to India or SEA can easily cost less than 1 month supply of some meds.)

StuartGale1 karma

We do get squeezed by price increases when the market runs short. We are paid mostly by the NHS so have no control over prices we are paid. We can currently buy from the EU. Who knows what will happen after Brexit

Silthoras3 karma

I heard that Insulin will be one of the biggest issues, as you can’t store it for long and it isn’t produced in britain. How real is the threat of an insulin shortage?

StuartGale2 karma

As far as I am aware the government bough up all the cold stores in the UK so there should be some back up.

SangEntar3 karma

I take blood pressure medication, such as amlodipine, atorvastatin, ramipril and bisoprolol. Do I need to be concerned, or will that be fine as normal?

StuartGale2 karma

Supplies are still there but low on some items - I think you will be ok because there are other choices - speak to your local pharmacy

Nerdthreepoint03 karma

Are people going to die because of this, and if so, about how many?

StuartGale4 karma

I don't think so - its is just going to be difficult for everyone

RazorwireRose3 karma

I’m not allocated more than a month of medication at a time as I’m a suicide risk.

How can I prepare if at all?

StuartGale2 karma

Ask the pharmacy to get it in stock ready for you tp collect on the day you need it.

luptartan2 karma

Do you think that a lot of the current supply issues are actually caused by the new FMD regulations (sealed packaging, QR codes etc)? I work in a pharmacy in south east England and a lot of the time when something that has been out for a while comes back into stock, we're seeing new packaging.

StuartGale2 karma

I think maybe you are right - new packaging always causes a supply issue - very annoying.

captainshat2 karma

Will brexit increase pressure on the government to develop orkambi and other drugs using a crown use licence?

StuartGale4 karma

I don't think they will be able to respond in time

Tammo-Korsai1 karma

Do you have any projections or information on epilepsy medication availability?

I take lamotrigine and thus I am concerned. I'm not instantly in trouble if I run out, but I would run the risk of reverting to daytime seizures which result in head injuries.

StuartGale2 karma

Supplies seem ok - don't leave it to the last minute to reorder though.

BoreDominated1 karma

My mother takes Clozapine and Sodium valporate for epilepsy, are those safe?

StuartGale1 karma

Some particular forms of sodium valproate are in short supply. I think clozapine is very tightly controlled so it should be better

lampcountess1 karma

How is the availability of progynova? My script has been changed from 3 months to 1 month which suggests issues...

StuartGale2 karma

It seems short at the moment - this has been the case over the last few months. It has been in and out

sh0ckwave-t1 karma

Will access to medicines in the future be difficult when we’re not prioritised in the EMA if we leave?

StuartGale1 karma

It will all be about profit. If the UK pays a good price for medicines then they will get the stock. If the manufacturers get better price abroad that is where the they will sell to in my opinion.

tenspot201 karma

As a working pharmacist, have you ever been paid or compensated for promoting one product over another? If so, which products and by whom and how much were you compensated? Are these "pay-offs" a common thing in the UK?

StuartGale2 karma

No we don't have a choice over what is prescribed. We just try to get the best value we can

tjen1 karma

I work in pharma, iirc we’ve been asked to build up ~6 weeks stockpile of drugs marketed in the UK, with some stockpiling/offloading waves, but with buildup again coming up on October.

https://www.google.com/amp/s/www.independent.co.uk/news/uk/politics/no-deal-brexit-medicine-stockpile-health-secretary-matt-hancock-nhs-prescriptions-a8504806.html%3Famp

I assume that’s the same for most pharmaceutical manufacturers who want to comply with the UK request and maintain market access. Especially for maintenance drug consumers, a shortage would be bad for them and just as bad for the pharma companies as they might move to other drugs.

What are your thoughts on that from the pharmacist side?

StuartGale1 karma

I am sure there is some stockpiling going on in pharmacies too. The trouble is that there are already lots of drugs we can get enough of for use today let alone 6 weeks!

bakamoney1 karma

Why will Brexit effect medicine supply in the first place??

Companies want to sell. And there's a demand. So ... Whats the issue?

StuartGale1 karma

I think there will just be delays to start with. Come companies may decide to supply the UK still - I suppose it depends if the product licence is still valid after Brexit

RPharmer1 karma

Canadian pharmacist here. How's the workload, work life balance, and compensation over there?

StuartGale1 karma

none good!

StuartGale1 karma

I think they are good links. https://www.mims.co.uk/drug-shortages-live-tracker/article/1581516 You can use this one but subscription required

StuartGale1 karma

I am sure she will be ok. There are lots of people that make levothyroxine and lots of different strengths. This should help in getting the right dose if there is a shortage

StuartGale1 karma

I don’t think they will be able to react quickly enough.

StuartGale1 karma

I am not sure about hospital supplies but I do know there will have been a lot of Brexit planning going on.

pillchangedmylife1 karma

Will oxybutonin hydrochloride be fine??

StuartGale1 karma

Seems ok at the moment

thsa004581 karma

I have a friend in Dublin who relies on NHS for access to her diabetes supplies from UK. How will she be affected?

StuartGale1 karma

In the same way but I would think they would have more flexibility with sourcing from the EU

monkeysatemybarf1 karma

I rely on a less popular contraceptive called Ortho Evra. Do you anticipate shortages of it?

StuartGale1 karma

Supply of this seems ok right now.

StuartGale1 karma

It seems ok at the moment

AsariCommando21 karma

I'll ask my pharmacy as well but any thoughts on Lumigan (bimatoprost ophthalmic solution)? That's for my glaucoma.

StuartGale2 karma

Lumigan seems OK at the moment.

saint_maria1 karma

I take propranolol for PTSD flashback management. It's my understanding that propranolol is used because it had a slightly different, wider effect than other beta blockers.

With this in mind, should there be a shortage, how will I be offered an alternative when this drug is so specific to my needs?

StuartGale2 karma

There are other beta blockers which may help. However no supply issue with propranolol at the moment. Its not a very high volume product so you may well be ok

Ezekeil2Ofive171 karma

[deleted]

StuartGale1 karma

They all seem ok at the moment.

scarybluesquirrel1 karma

Thanks for doing this AMA - I think it’ll do a lot to reassure people - even when the answer is just ‘we don’t know yet’. How are things going with biologics, eg Benepali, for rheumatoid arthritis that are delivered direct to patients?

StuartGale2 karma

I am sorry we don't get involved with direct to patient supplies I am afraid

RibShark1 karma

About two months ago I had trouble receiving Montelukast from the pharmacy due to a shortage, and since then I have been receiving different brands each time I pick up my prescription. Is it likely that another shortage will happen come November?

In the case that there is a shortage of that, one of my other asthma medications, or other medications such as anti-depressants, what methods would you suggest for me to be able to obtain them as quickly as possible?

StuartGale1 karma

Montelukast seems fine right now. If you have trouble getting what you need and it is out of stock - sometimes it is worth trying in a slightly different area where the demand is different. At OxfordOnlinePharmacy.co.uk we sometimes can get things like HRT which are unavailable around other parts of the country

backtoblack6-J1 karma

Hello fellow Oxford resident!

Do you know about the supply of mood stabilisers e.g. lamotragine? I’m only just becoming stable on medication. Thank you :)

StuartGale1 karma

Lamotrigine seems ok across the wholesalers right now

ParkieDude1 karma

Parkinson's Medication

What is the outlook?

How will trading be with Israel ( Teva Pharmaceutical being one supplied of generic Levodopa/Carbidopa)?

StuartGale2 karma

Teva is a major supplier into the UK generics market. I am sure they will have arrangements in place. There are no supply issues at the moment and there are lots of other manufacturers.

BrackDynamite1 karma

Do you think there would be shortages in dexampheatmine or lisdexampheatmine (Elvanse)? Since they're CDs I can't stockpile them and I'm a bit worried because my prescription won't run out until the end of the month.

StuartGale1 karma

No supply issues at the moment, you should be OK. Ask the pharmacy to get it in stock ready for your prescription. They may even keep one in for you for next time too

StuartGale1 karma

Thanks

StuartGale1 karma

Compounding / manufacturing medicines in pharmacies just wouldn’t be practical.

StuartGale1 karma

I’m not sure I understand your question

StuartGale1 karma

I don’t think anyone knows what is going to happen. This will make preparation very hard.

StuartGale1 karma

I don’t think they will. It’s just going to be very inconvenient for everyone and a lot of extra work.

StuartGale0 karma

With fentanyl there are lots of different manufacturers so hopefully you will be ok. You May need to change brand from time to time.

StuartGale0 karma

Drugs come from all over the world. I think everything is just going to move slower which may cause problems.

123fullthp-1 karma

As pharmaceutical supply is working today, I'm assuming the potential supply problems post-brexit will be caused by regulatory issues. Is this due to incompetence of the pharmaceutical companies or the British authorities?

StuartGale1 karma

Nobody knows what will happen which makes it quite hard to plan

II-MooseMan-II-4 karma

How might Brexit affect American pharmacy?

StuartGale2 karma

No effect in my opinion