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Mar 25 2020

“Preemptive” prescribing for COVID-19

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Image for “Preemptive” prescribing for COVID-19 Since this article was first published and emailed to licensees on or about March 25, 2020, the Board has adopted emergency rules that address the issue of preventive prescribing for COVID-19, at the request of NC DHHS Sec. Mandy Cohen, MD.

Coronavirus disease 2019 (COVID-19) has forced societal changes that most of us are still adjusting to, personally and professionally. Closures of schools, restaurants, bars and many retail businesses - not to mention the shutdown of professional sports – are a clear indicator of how very serious this situation is.

It’s no surprise that many are afraid. And while fear can be motivating, sparking both innovation and resilience in humanity, it can also bring out some of our worst impulses.

Over the past several days, NCMB and other health regulatory boards have received reports of inappropriate prescribing of chloroquine, azithromycin and other medications, apparently to have on hand in the event of a future COVID-19 illness.

While I feel sure that most licensed physicians and physician assistants would never misuse their prescriptive authority in this way, I feel compelled to state two of the most persuasive arguments against “preemptive” prescribing:

• Prescribing in order to stockpile medication – whether for personal/family use or to assist patients – is not an acceptable medical practice. Further, it is inconsistent with the ethics of the medical profession;
• Inappropriately prescribing chloroquine or hydroxychloroquine for possible COVID-19 treatment strains the current supply of these medications, making it more difficult for patients with conditions such as lupus or rheumatoid arthritis to obtain needed treatment.

It’s probably obvious to most physicians and PAs reading this message but, I’d also like to point out that, based on what we know of COVID-19, the vast majority of individuals infected with it will experience mild illness and likely will not require prescription pharmaceuticals of any kind. For most, the “cure” for COVID-19 is the same as it is for any viral illness – rest and fluids. Help patients understand this by referring them to the U.S. Centers for Disease Control and Prevention’s guidance for individuals who become sick with COVID-19.

Physicians and PAs can also help calm anxieties by adopting the strategies recommended by CDC to reduce transmission and clearly communicating with patients about them. Licensees should regularly check CDC and NC DHHS for coronavirus updates, or sign up to receive them by texting COVIDNC to 898211.

Thank you for all you are doing for your patients and your communities. If we all remember our training and hold fast to the ethics of the medical profession we will get through this together, and be stronger for it.

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