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Joint message from ACP and CPSA regarding inappropriate dispensing and prescribing of antivirals, antibiotics, and antimalarials during the pandemic

There have been anecdotal reports on social media, in the news, and reported to both the College of Physicians and Surgeons of Alberta (CPSA) and the Alberta College of Pharmacy (ACP) about the use of antivirals, antibiotics, and antimalarial therapies as a treatment for COVID-19 (this includes hydroxychloroquine, chloroquine, remdesivir, lopinavir/ritonavir, colchicine, and azithromycin, among others).

Prescriptions for these medications have increased significantly during the pandemic. Reports we have received include physicians prescribing them for “office use”, to themselves, to family members, and when there is no accepted indication (i.e., treatment of COVID-19 infection).

It is not appropriate for these prescribing behaviours to continue, as there are now serious concerns about shortages, misuse, and stockpiling of these medications. This presents challenges for patients suffering from chronic conditions (e.g. rheumatoid arthritis, lupus, and HIV) who rely on these treatments. There is also the continued threat of antimicrobial resistance developing as a result of antibiotic overuse.

During this challenging and unparalleled time, it’s natural for patients to seek treatments they feel might be helpful. However, it is important for all health practitioners to remember the importance of evidence-based care and prescribing. Medications must be prescribed and dispensed according to their approved use and currently, there is no proven treatment for COVID-19.

Please review the following standards, expectations, and guidelines:

  • The Canadian Medical Association’s Code of Ethics & Professionalism, specifically section C.6: “Recommend evidence-informed treatment options; recognize that inappropriate use or overuse of treatments or resources can lead to ineffective, and at times harmful, patient care and seek to avoid or mitigate this.”
  • ACP’s Standards of Practice for Pharmacists and Pharmacy Technicians, specifically standard 6.1, which before dispensing requires the pharmacist to consider if the indication “is approved by Health Canada, considered best practice or accepted clinical practice in peer reviewed literature or is part of an approved research protocol”, and standard 11.6: “A pharmacist who prescribes a medication must not prescribe a drug or blood product unless the intended use is an indication approved by Health Canada, is considered a best practice or accepted clinical practice in peer-reviewed clinical literature, or is part of an approved research protocol.”
  • ACP’s and CPSA’s COVID-19 resource pages.
  • ACP’s statement on this issue.
  • A statement from Physicians, Experience, Evidence and Research (PEER) on this issue.

ACP and CPSA recognize and appreciate your extraordinary efforts during the pandemic. Your diligence and dedication will support appropriate use, improved health and the continued availability of these drugs for those who need them most.