Doctors face sanctions for prescribing unproven COVID-19 drugs to friends and family, regulators warn

Medical regulators in Canada suspect some doctors have been stockpiling drugs that are being tested as potential treatments for COVID-19 and are now warning them they can be sanctioned if they prescribe the drugs to themselves or friends and family.

The drugs in question — hydroxychloroquine and azithromycin — are among a number of medications being studied as part of a global effort to fight COVID-19. So far, experts say evidence of their effectiveness in treating the disease is thin.

Hydroxychloroquine is currently used to treat malaria, rheumatoid arthritis and lupus, while azithromycin is an antibiotic for infections caused by bacteria and can be used in treating bacterial pneumonia.

U.S. President Donald Trump touted the drugs as potential "game changers" in a tweet last weekend.

Since then, the experimental combination of the two drugs has been widely discussed and debated online.

Spike in prescriptions

As a result, several regulators in Canada have reported a dramatic spike in prescriptions, including of another malaria drug, chloroquine.

"Globally, there are reports of physicians prescribing chloroquine or hydroxychloroquine to otherwise healthy patients for prevention of COVID-19," reads a directive from the Canadian Pharmacists Association issued Monday. 

"This practice threatens the Canadian supply of these drugs and will prevent their use in the sickest patients, in whom the benefit may outweigh the risks associated with these medications."

Regulators in this country are also reporting an increase in orders for the drugs from doctors who list it as "for office use." Typically, such requests are from doctors who want to keep a supply on hand for future use. 

They could be used off-label to treat patients, but there is concern those orders could also be used by doctors to treat themselves, or their friends and family who are concerned about COVID-19.

"At a time where resources are liable to become scarce, actions like [stockpiling and treating friends and family] dramatically depart from the core values of medical professionalism, may be in contravention of the College's [policies] and undermine the trust the public has in the profession at a time when they are most vulnerable," the College of Physicians and Surgeons of Ontario said in a recent notice to doctors.

'We wanted to act quickly'

The college says any complaints about doctors prescribing to friends and family will be investigated. The potential consequences range from providing advice to the doctor to referral to the disciplinary committee.

"We've heard some suggestion this is happening. We thought it was important to address it given the severity of the situation," said college spokesperson Shae Greenfield.

"We wanted to act quickly."

A statement from medical regulators in British Columbia issued Thursday made similar warnings.

"More British Columbians will become infected and tragically, more may die from this virus," says a joint statement from B.C.'s College of Physicians and Surgeons, College of Pharmacists and College of Nursing Professionals.

"This means the well-intentioned pressure from patients, fellow health-care workers, and even friends and family to help access these medications, will undoubtedly increase."

Except when there is a clinical trial, the statement instructs both doctors and pharmacists not to provide the drugs as a treatment for COVID-19.

Jim Giontsis, co-owner of Moss Park PharmaChoice in Toronto, confirms he saw an initial rush of orders for the drugs, including some requests "for office use." 

"When [doctors] order it for the office, it could be for their patients, their staff or personal use," he said. 

"We have to limit that now. We have limited supply now. We need to be very careful now to try to be fair to everyone."

'Very serious shortage'

The increased demand has already led to shortages for patients needing the drugs to treat other diseases.

A joint directive from medical associations in Ontario issued Monday says they are now facing a "very serious shortage" of hydroxychloroquine. 

"This presents very serious challenges for long-term continuity of care for patients suffering from rheumatoid arthritis and lupus," says the directive from Ontario's Pharmacists Association, Medical Association and Registered Nurses' Association.

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The statement also says there is a "serious lack of evidence" for using the experimental drug to treat COVID-19 and warns about the potential side-effects, which can include heart damage.

"Our patients expect us to protect them to the best of our abilities, and with all health professions rallying together, we will ensure that our patients are well cared for and that their confidence in us — and in the drug supply — is well founded."

For tips, please contact Timothy Sawa at timothy.sawa@cbc.ca