The Chatelaine's Keys

Sharon March 25th, 2008

A while back a reader who depends for her life on daily medication emailed me asking what her options were in the case of a major disruption of supplies.  I’ve had occasion to think about these things before – for example, as I was writing the chapter on health care in _Depletion and Abundance_ and when thinking about family members, some of whom are equally dependent.  But it was helpful to sort out and organize things.

To start with, everyone who depends on a medication should keep a 2 week supply, plus duplicate copies of their prescriptions.  This is an absolute minimum, again, the FEMA/Red Cross minimum, and it reflects the reality that in a bad crisis, it is not unlikely that you may be unable to get a refill for several weeks.

 This does mean that you have to pay close attention to rotation – some medications (insulin for example) have a comparatively short lifespan.  Most have a mid-range one, and gradually lose potency, but there are a few that actually become toxic if they’ve been stored too long.  If you don’t know what the storage life and issues are with your medication, you should call the drug company that makes it and find out.  Ask them how they figure out storage lives and what the potential consequences of taking out of date drugs are.  Write the information down for all prescriptions you depend on.  And if you do take a short lifespan drug, you’ll need to be super-careful about using up the oldest first and keeping your supply updated.

Most over the counter medications can be safely used past their expiration date, but again, this is something you’ll want to research.  There are simply too many such drugs, and their compositions vary from brand to brand and country to country for me to provide a reliable list of OTC and Herbal preparations their storage lives.

I would also recommend that you keep up-to-date copies of your prescriptions (including, if you use them your glasses prescription) and your medical records somewhere easily accessible along with important papers so you can grab it if you are forced to evacuate.  It can be very difficult to find someone to write you a prescription in a crisis, and you don’t want to be without them.  The medical records are absolutely *imperative* if any of the medications you depend on are controlled narcotics (which odds are you won’t be able to get an extra prescription for) - because convincing a strange doctor in a strange place to give you a controlled substance is likely to be difficult.

Most medications are best stored in a cool, dark, dry place.  You might want to double zip-lock them or otherwise store them in as airtight way as possible to slow degradation if you are holding them for a longer period.  It should go without saying that all medications must be stored away from where children can get them, in childproof containers.   

What about drugs that require refrigeration?  What do you do if the power goes out?  In most parts of the country, water comes up from the ground fairly cool, and storing drugs in buckets of water, or dug holes in the ground will keep them cool enough for a short time.  If you have a creek or other water source that is cool, you often can seal the drugs in a container and submerge the container (don’t let it get washed away, obviously) in the creek.  In a short term emergency, with no way to keep needed medications cool, having a functional person go for help is probably the best solution.

What about longer term social disruptions, or major supply problems?  What if two weeks is not enough?  Well, it certainly would not be unwise to store larger quantities of most medications if you can – 3 months would probably be prudent, and if you can afford to buy it up front, it protects you as well from price fluctuations.  The difficulty is that many people cannot afford 3 months advance medication, and their insurance will not pay for it.  And those taking scheduled narcotics usually cannot get any more than an immediate supply.  Add to that the fact that eventually, in a serious crisis, stores will run out and what do you do?

My own feeling is that you should take a “belt and braces” approach – that is the more ways you have to hold up your pants or ensure your supply of medication, the better.  After all, your life is worth it.  So you do what you can, with what you’ve got.  You might want to make use of several of these strategies.

I should add that I personally think that the most likely scenarios are less about total disruption in supply than about increasing numbers of people unable to afford their drugs.  That, of course, is the reality in many places in the world where a diagnosis of an expensive disease simply means death.  But there are good and compelling reasons to avoid becoming one of those places – this is the subject for another post, but in _Depletion and Abundance_ I outline how we might create a low cost, localized “shadow” health care system that could meet a lot of needs both during a crisis and right now, for the millions of uninsured.  I believe passionately that Peak Oil and Climate Change advocates need to focus in on sustainable health care and add it to their agendas – because we have evidence that it is possible to have long lifespans and reasonably good health along with very low expenditures on health care.  But that, of course, is a discussion for another day.

But anyway, while it is technically possible imagine drug manufacturing simply stopping, it seems more likely to imagine sketchy supplies, not being able to get preferred drugs, and not being able to afford needed medication.  And I do want to caution people not to panic here – yes, plan.  But don’t assume that any crisis is inevitable.

Ok, so the first solution would be to store a larger supply.  If you are taking a narcotic, or using a short lived drug this is particularly difficult, but a friend of mine says that sometimes she is able to skip a dose, and when she does, she puts it aside - by refilling immediately and occasionally enduring quite a bit of pain, she has managed to put a small reserve aside.  Only you know if that is possible for you – but it might be worth trying.

If your current drugs are short-lived, it might be worth researching whether there are alternatives you could shift over to.  In fact, this is probably worth looking into for everyone – that is, if your drug is available in multiple forms, know what they are – one may be in short supply when another is available.  There are risks, of course, in any such substitutions, but being able to get ahold of a functional substitute is probably less risky than going entirely without.

What happens if there is a long term crisis and no way of getting your drugs at all?  Well, there are a couple of options.

1. First, is there a non-pharmaceutical company alternative.  In many cases, there will not be – but sometimes there are.  For example, those on heavy pain medication may be able to rely on homegrown opiates, marajuana (legal for medical purposes in some states and legal for anything in some countries), or alcohol for pain relief (note, this blog might get in trouble if I suggested you do illegal things, so FYI only). 

Some prescription medications can be substituted with herbal preparations – some quite successfully, some not very.  But it is worth noting that many drugs are herbs – or were in origin.  It is not worth dismissing herbal medication out of hand.  Talk in advance to a naturopath or other practitioner and to your doctor. 

Sometimes you can reduce your need for a medication partly or entirely by lifestyle changes.  Many of those with high blood pressure, for example, could manage it with diet and exercise alone if they really had to.  Giving up a western diet and eating very low on the food chain, and exercising a *lot* will suck badly if you are already unhealthy – but it might be better than the alternative.  A friend of mine with type 1 diabetes tells me he can halve his insulin requirements by careful dietary control and extensive exercise.

2. Have a plan for ensuring supplies.  If you can imagine a crisis in which drugs continue to be manufactured in some places, but just aren’t getting to you (what most crises have looked like in most of the world recently), it might be worth getting a group of concerned citizens together and contacting pharmaceutical companies about ensuring supplies during periods of disruption (you might mention climate change, Katrina, avian flu – just in case peak oil doesn’t cut it ).  That is, while one person is not a very powerful entity with a company, a city or state or regional group made up of people with medical dependencies might be able to work out supply delivery plans and direct purchasing for an extended emergency.  They might not – I have not tried this.  But advocacy groups are powerful.

 My own suggestion would be to start at the municipal or county level, and consider organizing from there, perhaps linking community groups together to contact major pharmaceutical companies directly.

3. Go Local.  Now this is not going to be possible for a majority of drugs, but some very simple chemical combinations can be made in college or even a good high school chemistry lab. I am not a chemist and I am not an expert here – but several chemistry professors and high school chemistry teachers did tell me that they could manufacture a number of drugs that had comparatively simply formulae.  Antibiotics, thyroid medications and heart medications were among those mentioned as particular accessible – if they had the relevant materials. 

Some of those chemical materials are cheap and fairly shelf stable.  It is not impossible that some drugs could be synthesized locally – and make a rather good business for a chemist.  My own recommendation would be to do some research into your drug (generally, it will be possible to find the formula if it is no longer proprietary information of a single company, so if you have a choice of medications, you want the oldest form in many cases)  and to talk to graduate students or professors at your local university or even a high school chem professor about your fears about the future and your desire to find a local solution.  It will not be possible in every case – maybe even most cases, but it is better than just accepting death.

This is not an easy issue once you get outside the short term.  But it is worth thinking about – and thinking hard.

 Sharon

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