Markian Hawryluk | The Bulletin | August 26th, 2018
When her son’s EpiPen hit its expiration date earlier this year, Narly Lemus called every pharmacy in Bend looking for a replacement for the device, which injects a dose of epinephrine to stop a life-threatening allergic reaction. When she was unable to find one, his doctor rewrote the prescription for an adult version. Lemus finally tracked one down, waiting three hours for the prescription to be transferred to the new pharmacy before nabbing their last one.
“It’s a totally different pen that is harder for my son to operate,” Lemus said.
Parents throughout Central Oregon are struggling to find EpiPens for their children as they prepare to go back to school due to manufacturing shortages that have wiped out supplies across the country.
That’s left patients and their doctors trying alternative products and workarounds to protect children and adults from potentially life-threatening allergic reactions.
Andres Lemus, 8, knows how to use the EpiPen Jr. The product comes with a package of two auto-injectors with a practice pen that helped him learn the technique. The alternative product comes with one only injector and no practice pens.
“What we’ve done is we watched a video that walks him through it,” Lemus said. “But there’s more steps to it. So my concern is, is he going to be able to do it?”
Manufacturing issues have led to shortages of both adult and child versions of the Epi-Pen and Adrenaclick injectors. A third version, the Auvi-Q, is in high demand.
“This is a really huge deal for quite a lot of families today,” said Dr. Logan Clausen, a pediatrician with Central Oregon Pediatric Associates. “There isn’t a pharmacy in Bend that currently has any in stock or can tell us when they will get some.”
Epipens usually expire after a year. Pediatricians normally renew those prescriptions as children come in for their well-child visits before the start of school.
“Our only option is to prescribe epinephrine in a vial and have the family draw up doses in a syringe,” Clausen said. “This is clearly not ideal for many reasons, including that you cannot walk around with a syringe in your pocket or purse, you can’t bring a syringe to school, there’s a huge chance of dosage error and the injection is much more difficult to administer than the pen.”
The Food and Drug Administration has taken steps to help alleviate the shortage, including extending the expiration date on some lots of the EpiPen by about four months. Studies have shown that as long as the liquid inside the device has not turned cloudy, the epinephrine inside can retain most of its effectiveness for months if not years after the expiration date.
“We always encourage families to stay up to date with their EpiPens because you never want to put your child’s life in play with the limited studies that we have,” said Dr. Adam Williams, an allergist with Summit Medical Group Oregon-Bend Memorial Clinic. “EpiPens last longer than the expiration date.”
If patients are concerned that an EpiPen is not working or if they’re uncomfortable with using an older product, Williams advises them to call 911.
“An ambulance will come with epinephrine for you,” he said.
This month FDA approved a new generic autoinjector but it’s unclear when the product will be available for sale.
Many parents opt to have their child carry an EpiPen with them at all times, but leave a second at school. Tami Pike, health supervisor for Bend-La Pine Schools, said the district gets up to four EpiPens per school under the manufacturer’s EpiPen4Schools program. But if kids are out on field trips, schools don’t have enough to send one with every class.
“We’ve given a few Epi-Pen (injections) in the school district for kids that had no diagnosed allergy,” Pike said. “You have your kids with their diagnosis and they have their Epi-Pens, but you also have students who aren’t on the radar.”
Last year, the school district had fewer than five cases where students had an allergic reaction and needed an epinephrine injection. But schools can’t guarantee one will be available if students don’t bring in their own.
“We need more EpiPens,” Pike said. “It’s frustrating on our part and the parents’ part.”
Mylan, the pharmaceutical company that markets the EpiPen, sent a letter to schools in May notifying them that deliveries of the devices could be delayed this school year due to the supply problems. Pike said Bend-La Pine Schools have already received their EpiPens for the upcoming school year.
Local pharmacists say their wholesalers get only limited supplies that are claimed as soon as they become available.
“We will have to do a buy at that moment to make sure we get some,” said Kristen Godfrey, owner of Westside Pharmacy in Bend. “If we just put it (in) our cart and submit it at the end of the day, they’re already gone.”
Godfrey suggests patients check the expiration date on the box, rather than the prescription label, and to check whether the lot number is part of the extension announced by the FDA.
“For some people, this is a panic situation,” she said. “Ideally, you never have to use it. But then we have families where there are several people who have life-threatening allergies, and this is pretty stressful for them.”
Williams said his office has been fielding phone calls from parents who have had trouble finding an EpiPen, and if a pharmacy has an alternative injector available, he can change their prescription.
“I will almost always demonstrate all three,” he said.
Lemus says she is still trying to find the EpiPen Jr. model that her son knows best. Andres first showed signs of nut allergies as an infant and wound up in the hospital after an exposure as a toddler. A few years ago, she had to rush to his school to administer an EpiPen injection after he touched some peanut butter.
“He’s pretty good about it now,” Lemus said. “He can tell what is now so he can stay away from it.”