At the end of December 2022, a recommendation from the National Medicines and Health Products Agency (ANSM) reported “high supply tensions for amoxicillin-based drugs”, this antibiotic used against dental, skin or ENT infections. notably. At the heart of this shortage, solutions in vials, mainly prescribed for children. To counter this lack, the ANSM called on pharmacies to set up a network of pharmacy assistants. Among the 21,192 pharmacies listed in France in 2017, only about forty are able to produce amoxicillin capsules in sufficient quantity to keep stocks afloat.
Fewer and fewer magistral preparations in pharmacies
Although magistral preparations (medicines made in pharmacies) are still authorized in all pharmacies, time has pushed more and more pharmacies to abandon, in part, the preparation of “home” remedies and medicines: ointments, syrups, infusions or even tablets and capsules. “At least until the middle of the 20th century, the job of a pharmacist was to manufacture and sell his drugs,” explains Philippe Besset, president of the Federation of Pharmaceutical Unions of France (FSPF). But the strong industrialization of the pharmaceutical sector and the tightening of health and safety rules have upset the world of pharmacy. From the 1970s, the majority of solutions sold in pharmacies came from industrial pharmaceutical production.
For many pharmacists, the financial investments necessary to adapt their preparations, these laboratories located in pharmacies and intended for the manufacture of drugs, to the new legislation are proving too costly. Others make the opposite bet.
Among the nearly 20,000 French pharmacies, between 200 and 400 are authorized by their regional health agency (ARS) to produce remedies on behalf of other pharmacies, such as dermatological creams, cough syrups, medicinal adaptations for children… Among them, about forty have made it part of their activity, taking charge, in subcontracting, of the preparation of magistral preparations prescribed for a large part of the other pharmacies. “All the pharmacies are still equipped with a preparatory, with a minimum of material, for simple preparations of mixtures. But for more technical solutions, we go to these forty subcontracting pharmacies, ”explains Bruno Maleine, pharmacist and president of the Central Council of pharmacists who hold pharmacies for the National Order of Pharmacists. “Today, in my preparatory, I no longer manufacture anything, says Philippe Besset. I subcontract each preparation to another pharmacy which delivers to me within twenty-four hours. »
ANSM turns to pharmacies
Serious supply tensions on certain drugs raise questions about the dependence of pharmacies on the pharmaceutical industry. Latest, amoxicillin. Fabien Bruno, incumbent pharmacist at the Delpech pharmacy in Paris, manages the largest of the 42 subcontracted pharmacies. At the end of December 2022, the ANSM asked them to “provide a solution at their level”, he recalls. “This is the first time that subcontractors have been asked to set up production capacities to help the country through a shortage. »
Between the end of December 2022 and January 8, 2023, the forty pharmacies involved produced nearly 30,000 pediatric amoxicillin treatments, i.e. nearly 10% of production. “Can you imagine if there were 400 pharmacies? or 4000? “Asks Fabien Bruno. With more pharmacies in its path, the pharmacist already imagines doing more to help during future supply tensions. “Magistral preparation is not going to replace the pharmaceutical industry. But it can hold the system together during tensions over certain drugs,” he explains, assuring that the public authorities are “really engaged” on the subject.
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