A chemist displays hydroxychloroquine tablets on April 9. Hydroxychloroquine and a similar drug, chloroquine, have been promoted by President Trump since some early tests suggested they might curb coronavirus. Associated Press/Manish Swarup
Some Maine doctors have been prescribing drugs clinically unproven to treat COVID-19, even to themselves or to patients with no diagnosis, prompting the state Board of Pharmacy to issue guidance cautioning against the practice.
The Board of Osteopathic Licensure and the Board of Licensure in Medicine – which regulate doctors across the state – also are expected to issue a joint statement offering guidance to physicians.
The osteopaths’ board met last week and voted to go ahead with guidance, executive secretary Susan Strout said. The board that licenses allopaths, or medical doctors, was meeting Tuesday, and its office did not respond to a message from a reporter.
Pharmacy board chair Joe Bruno said Tuesday that members held a virtual meeting on Friday and voted to distribute a statement about the drugs chloroquine, hydroxychloroquine and azithromycin for treating COVID-19. The drugs have been touted by President Trump and others but have not been proven clinically to treat the disease caused by the novel coronavirus. The drugs typically are used to treat other diseases.
“Pharmacists should use their professional judgment and take appropriate steps to verify that newly issued prescriptions for chloroquine, hydroxychloroquine and azithromycin are issued for legitimate medical purposes and not for prophylactic treatment unless consistent with prescribing guidelines of the Food and Drug Administration and the Centers for Disease Control and Prevention,” the statement reads. “To prevent drug shortages, pharmacists should contact prescribers to confirm the diagnoses of patients newly prescribed these medications, and pharmacies should refrain from inappropriately stockpiling these medications.”
Bruno, who also is president of the Community Pharmacies chain in southern Maine, said if patients are being prescribed the drugs for COVID-19 – even though there is no consensus on their efficacy – they should have a diagnosis. Additionally, the board advised that prescriptions should last no longer than 14 days. Patients without a diagnosis should not receive prescriptions.
The board’s guidance follows reports in Maine and elsewhere of health care practitioners prescribing the drugs, sometimes in large quantities, for themselves, family members or patients without symptoms of COVID-19. Two weeks ago, Bruno said a doctor prescribed a patient who had no symptoms with a 100-day supply of chloroquine, and one of Bruno’s pharmacists said no.
“There is nothing illegal about prescribing for yourself or family, but there is an ethical question,” Bruno said. “Early on, people were saying, ‘I want my family to have some, just in case.’”
Pharmacists cannot tell doctors what to prescribe, or how much, but they can refuse to fill prescriptions.
The risk in prescribing the drugs to patients who don’t need them is that it will create a shortage for others who use them for other diagnoses, such as lupus and rheumatoid arthritis. Chloroquine also is used to treat malaria.
Bruno said he’s not heard reports of a shortage of those drugs in Maine, but officials want to avoid that.
The debate over the efficacy of the drugs has become, like so many other things, political. Trump seized on them as a possible treatment long before they had been studied for COVID-19, which led to the FDA granting emergency approval for the use of the drugs at hospitals, and also spurred increased production by pharmaceutical companies.
In March, Trump said the pairing of hydroxychloroquine and azithromycin had “a real chance to be one of the biggest game changers in the history of medicine.” He’s touted it at several briefings since, despite hesitation from his top infectious disease expert, Dr. Anthony Fauci, who warned against making claims until the drugs’ use against COVID-19 can be studied further.
Other medical experts have not been as bullish about the drugs, which have shown promise but have dangerous side effects. Some early studies have produced grim results.
The New York Times reported Monday that a study in Brazil was halted after 11 people died from heart arrhythmia they developed after being given the drugs.
Other countries, including France and Sweden, have discontinued the use of chloroquine and hydroxychloroquine since patients there developed heart problems.
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