By Glenn Howatt
Star Tribune
SAINT PAUL, Minn. — A nationwide shortage of EpiPens has Minnesota families and pharmacies scrambling to obtain the lifesaving medication devices, which are often the only option for people having severe allergic reactions.
The shortage is one of several that have hit the nation’s drug market recently, including a new shingles vaccine, prompting federal lawmakers to call for the government to address gaps in pharmaceutical manufacturing.
It also means that families affected by serious allergies have one more thing to worry about on top of the vigilance required to protect their children from dangerous exposures.
“I spent two weeks and many hours trying to find EpiPens,” said Mary Schlief of Howard Lake. “I was in tears. It is very frustrating because you have to have them.”
Schlief’s two children have allergies that require them to keep EpiPens within reach at all times. She needs them as well; she recently had an allergic reaction to the insulin she was taking for diabetes.
The medication in the pen, epinephrine, reverses the physical effects of an allergic reaction, which can include hives, swelling, throat closure and even cardiac arrest. It is the same thing as the body’s hormone adrenaline.
“It is like you had 15 cups of coffee,” said Schlief, describing how it felt after she gave herself the shot. “Your heart is going so fast.”
The pens are also carried by people who have severe reactions to mosquito bites, bee or wasp stings, or need it for chronic conditions such as asthma.
The shortage first emerged in May after Mylan, the pharmaceutical company that markets EpiPen, and its partner Pfizer, cited delays from third-party suppliers, which they predicted would last a few weeks.
But it has not abated, and actually intensified as children returned to school this fall. Some schools require students with allergies to keep the devices onsite for emergencies.
Schlief was finally able to obtain some pens, but not as many as she wanted. Pharmacies are rationing them because of the shortage, she said.
“You finally find one, and they only give you one two-pack for each of my children. That is all I can get right now.”
In addition to carrying the pens at all times, many families keep extra sets where they might need them—at home, at day care and with grandparents, in addition to the set at school.
Having two pens is important because one shot is sometimes insufficient, or a second injection might be needed if an ambulance gets delayed.
“You need to have this medication on hand,” said Nona Narvaez, an advocate who founded the Anaphylaxis and Food Allergy Association of Minnesota. The ongoing shortage “is throwing a whole wrench into some of families’ planning and medical care.”
A generic version of the pen marketed by Mylan is also in short supply, putting pressure on supplies of two other versions.
Pharmacies across the Twin Cities say the EpiPen shortage is one of many they are facing as they struggle to keep medications in stock.
“About a month and half ago we were completely out” of the generic version of Mylan’s EpiPen, said John Hoeschen, an independent pharmacist who owns St. Paul Corner Drug in the Macalester-Groveland neighborhood. Thanks to a stable of nine vendors, Hoeschen said, he has been able to restore supply and keep up with demand.
Both HealthPartners and Fairview Health Services said they have had occasional shortages at their pharmacies. Managing supply has become a daily job at both systems, and Fairview has recently hired a supervisor whose sole job will be to manage shortages.
Online inventories, they said, help them direct customers to locations with supplies of the pen they need.
For some parents, the shortage means they can’t get the particular pen that they want.
When Brandi Stewart tried to pick up an EpiPen refill for her 10-year-old daughter at the pharmacy, she was instead given a generic injector that has an exposed needle. The EpiPen’s needle does not emerge until the plastic tip is pressed against the body, something that many people feel is safer and less intimidating for young children.
Until now, the EpiPen is the only injector her daughter has known and she has “practiced and practiced” with test models for the day that she might need it.
The pharmacy “said this is all we have,” said Stewart, who lives in Lino Lakes. Since her daughter needs the medication, Stewart said, “we are not going to say no.”
“If she has to self-administer, she won’t know how to use this one,” said Stewart. “This needle is fairly long and that is intimidating. To me it is very scary, especially for a child.”
U.S. Sen. Amy Klobuchar, D-Minn., is one in a bipartisan group of 31 senators who urged the Food and Drug Administration in June to address the shortages. She expressed concern about the recent EpiPen shortage.
“As the mother of a daughter with allergies, I know the worry involved in sending your child to school at the beginning of a new school year,” Klobuchar said in a statement. “Parents shouldn’t also have to be concerned about how they are going to get the medication that keeps their kid safe.”
In an attempt to ease some of the squeeze, the FDA has extended the typical 20-month expiration date on some EpiPens by four months. But the medication, which cannot withstand extreme heat and cold, is inherently unstable and loses effectiveness over time even in good conditions.
People who are having trouble obtaining the pens can consult Food Allergy Research and Education in McLean, Va., which has a list of resources on its website. Mylan said its customer service number at 800-796-9526 can assist with locating pharmacies that have the pen.
Copyright 2018 Star Tribune