BISMARCK — The head of the North Dakota Board of Pharmacy says the agency is exploring steps to safeguard inventories of drugs that hold promise as weapons against the coronavirus, drugs that are also critical for people with autoimmune disorders.
The drugs in question include hydroxychloroquine, which is commonly used as a treatment for maladies such as malaria, lupus and rheumatoid arthritis.
Hydroxychloroquine has not been approved by the Food and Drug Administration as a safe and effective treatment for coronavirus, but the agency is fast-tracking research in that area, and small studies and anecdotal evidence hint that it could play a role in the battle against the pandemic.
Hydroxychloroquine and the similar drug chloroquine have shown promise in reducing coronavirus counts in the lab but have not shown effectiveness in mice. A handful of reports have claimed the drugs reduce the illness, but those studies have been characterized as flawed. Proof of the drugs against coronavirus in the form of positive randomized controlled trials, the accepted measure that a drug is both safe and effective against an illness, do not exist.
However, news accounts of the potential benefits of hydroxychloroquine in battling coronavirus have reportedly prompted some doctors in the country to hoard such medications by writing prescriptions for themselves and family members.
That has prompted pharmacy boards in states such as Idaho, Kentucky, Ohio, Nevada, Oklahoma, North Carolina and Texas to issue emergency restrictions or guidelines on how the drugs may be dispensed at pharmacies.
North Dakota is considering taking similar steps, either through an executive order via the governor's office or by the state pharmacy board imposing emergency rules, said Mark Hardy, executive director of the North Dakota Board of Pharmacy.
Hardy said an executive order would take effect quicker than emergency rules from the board.
"We definitely are aware of it," Hardy said, referring to hydroxychloroquine and concerns nationally over how it is being prescribed.
"We put out guides to our pharmacies, making sure they are using prudent choices as far as their dispensing (of hydroxychloroquine) and ensuring that it is for a legitimate purpose and making sure there is that supply for people who are on the medication for maintenance therapy," he added.
Hardy said a recent survey of some pharmacies in North Dakota showed the state had an inventory of about 90,000 doses of hydroxychloroquine.
He added it wasn't known, however, how many patients in the state rely on the drug for maintenance therapy.
Hardy said the state board has heard reports of questionable prescribing going on in North Dakota, and pharmacies have been "making the prudent decision not to dispense those."
If pharmacists feel a prescription is inappropriate, Hardy said, the state board is urging them to decline to fill such prescriptions or ask for more information before filling them.
As more patients in North Dakota receive a diagnosis of COVID-19, he said, supplies of hydroxychloroquine will become more critical, particularly for people who rely on the drug.
"The biggest thing is to assure those patients that they're going to continue to have access to those medications," Hardy said, adding that if the drug is going to be expanded for use in the battle against the coronavirus, the most critical cases will likely be addressed first.
"As we continue to see this pandemic spread, we're looking for solutions," he said, adding, "Certainly in those that are critically ill, it might be an important tool for clinicians to have."
The use of hydroxychloroquine in treating acute cases of coronavirus is already happening at a Fargo hospital.
Avish Nagpal, an infectious disease doctor at Sanford Medical Center, said the coronavirus is spreading so fast there is no time for a full clinical trial at Sanford.
Rather, hydroxychloroquine is being used to treat specific patients who have acute infections, and doctors are watching how they do, Nagpal said in an interview with WDAY.
"These things are easier to do in chronic diseases like diabetes, hypertension and things like that, but when a disease is so acute and it's making you so sick, it's hard to do a clinical trial," he said.
Nagpal said ideally everyone would get the drug, but hospitalized patients will likely take precedence for hydroxychloroquine.
People should not consume products containing hydroxychloroquine unless they are prescribed or given them in a hospital, he cautioned.
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