Speaker 0 00:00:00 My name is Sheena Mitchell. I'm a pharmacist and mom of three. I combine healthcare and practical advice to support your family's health. Everyone knows that the medication ozempic has been in the news a lot lately. I wanted to take a little bit of time to explain to people exactly what Ozempic is and most importantly, to try and give Ozempic patients a voice. Patients prescribed OZEMPIC for any reason are struggling with supply at the moment. Recently I conducted a patient survey with 131 patients who've been prescribed ozempic. Ozempic is the brand name for an injection which contains the drug semaglutide. At the same time, I've also been conducting a survey of community pharmacists in Ireland and their experiences of the ozempic shortages, and I'll share that perspective with you over the coming weeks. Today I want to focus more on the patient side of things and I think first of all, it's important to explain to people who don't know what ozempic is, how it works. Speaker 0 00:01:00 So OZEMPIC is licensed for the treatment of adults with insufficiently controlled type two diabetes as an adjunct, so an add-on to diet and exercise that is the licensed indication of the product. Before I start, I want to explain that there is another GLP one analog called Saxenda, which is indicated as an adjunct to a reduced calorie diet and increased physical activity for weight management in adult patients with a BMI of over 27, Saxenda is more expensive than ozempic. Importantly, there are also shortages of saxenda being experienced because of product licensing and supply issues. Pharmacists find themselves in a pretty difficult position. It is the H P R A and manufacturer that have licensed ozempic for the treatment of diabetes and not weight loss by the H P R A licensing. We have been told as pharmacists that this medication is for use in diabetes. Saxenda is actually licensed for weight loss, but as we know, it's even more expensive. Speaker 0 00:02:11 It's covered under state funded schemes in certain quite restricted conditions by the hse, but it is the HSE that have chosen to only support certain patients. I have been informed that ozempic is over the counter and widely available in Mexico, meaning that you don't need a prescription for it and they're not having supply issue. If there is no supply issue in Mexico, you do have to ask yourself why there is one here. Again, this is not the fault of your local pharmacist. Pharmacists would be relieved and less stressed and upset if GLP one analogs were licensed for weight loss and reimbursable under state schemes. It is the state that is causing this US and them narrative, which quite simply shouldn't exist. Patients don't want this divide and pharmacists certainly don't want it either. Communication of these factors can be really difficult in a busy pharmacy with patients being asked by counter assistance what the prescribed indication is. Speaker 0 00:03:13 Everyone is doing their best in a health system that is becoming increasingly difficult to work in. Patients are left feeling shamed and frustrated, and an unfair story is the result. I implore all patients to contact their local TDS and the HSE to demand a more robust response to obesity in Ireland. Pharmacists are healthcare professionals who can see the tsunami of healthcare issues coming as a result of obesity. We are not your enemy. In fact, we support you on a day-to-day level. Communication can be fractured and difficult as we work under burdenous bureaucratic procedures added to our workload daily by the hse. Look at the caravan rollout as an example. Hours of pointless work for pharmacists, which results in us disappointing our patients. Once more shortly, I'll be sharing some responses from the survey from patients who are on ozempic and it's clear that pharmacists in lots of cases are getting the blame, but pharmacists are not to blame here. Speaker 0 00:04:13 We need to demand change in the name of public health. We need to channel our upset and frustration in the right direction. Contact the hse, contact your local tds, contact the H P R A. Pharmacists stand in support of our patients and I will not allow policy failures to damage our hard-earned supportive relationships with our customers, and that is why as a pharmacist, I wanted to share the patient journey. Okay, so back to ozempic. Patients start on a weekly dose of 0.25 milligram and after four weeks, they increase to 0.5 milligram once weekly. After four weeks, the dose can be increased further to one milligram once weekly to further improved glycemic control. If after four weeks at that dose even further control is needed, the dose can be increased to two milligram once a week. This is the highest recommended weekly dose. Patients inject themselves using a prefilled pen. Speaker 0 00:05:10 It's a subcutaneous injection into the abdomen, thigh, or in the upper arm. Women of a childbearing age are recommended to use contraception when being treated with ozempic and it's not recommended for use in pregnancy or breastfeeding. Semaglutide delays the rate of gastric emptying. Side effects include nausea and diarrhea, which are very common and occur in more than one in 10 people. Other side effects include vomiting, abdominal pain, abdominal distension, and constipation, which are common, which means they occur in more than one in 100 people. Nausea and diarrhea are most common in the first month of treatment and in patients with a low body weight. So how does ozempic work? I'm gonna try and simplify this a little bit. Ozempic is a glucagon like peptic analog, which binds and activates the GLP one receptor, which human GLP would normally bind to. So OZEMPIC is known as a GLP one analog to make that more understandable. Speaker 0 00:06:13 GLP one is a physiological, so natural hormone that mediates appetite and glucose regulation. It reduces body weight and body fat mass through lowered energy intake and overall reduced appetite, and it also reduces the preference for high fat foods. It is no wonder that doctors are prescribing ozempic to assist obese patients to lose weight. Ireland has one of the highest levels of obesity in Europe with 60% of adults and 20% of children living with obesity and being overweight. According to the obesity national clinical program from the hse, obesity is defined by the World Health Organization as abnormal or excessive fat accumulation that presents a risk to health. It is a progressive, chronic and complex disease affecting all ages and genders bmi, so body mass index is the most widely used measure of obesity in clinical practice, and whilst it's not a perfect index, it is the best way when a direct assessment of body fat is not readily available. Speaker 0 00:07:22 Everyone is aware that obesity is associated with other chronic diseases such as type two diabetes, cardiovascular disease, respiratory disease, several types of cancer pain and musculoskeletal disorders. It's clear that avoiding weight stigma in both the healthcare and societal level is optimal for patient health. If stigma is not tackled, then people will be slower to seek help and it can result in greater psychological distress. This distress can worsen obesity. On a personal level, I feel we need an empathetic health system which supports our patients holistically to optimum health. As a businesswoman, if I was the hsc, I would be very keen to provide resources to tackle obesity as the financial costs of not doing so will be epic in the short to medium and long term. Treating the conditions associated with obesity will be a lot more expensive than treating obesity directly. Finally, as a human, I don't want anyone to feel unsupported with obesity or to feel hopeless and unhappy in themselves. Speaker 0 00:08:28 It is incredibly difficult to live with hating yourself, and so if a patient wants support, I feel they should be offered every available resource. Over the past two weeks, I have collected patient responses to a survey titled Patient Experience of Ozempic Supply in Ireland. I collected 131 responses. This showed that of the 131 patients who answered 22.9% were prescribed it for diabetes, 77.1% were prescribed it for weight loss. The respondents represented patients from 23 of the 26 counties of Ireland. 91.6% had experienced difficulty in getting a supply of ozempic in the past 12 months with 43% having difficulty every single month and 33.6% having difficulty one or two times every three months. This is not good for patient compliance or treatment. 89.3% of all 131 patients reported feeling distressed about the difficulty they're having obtaining ozempic. In this episode, I want to represent the patient's perspective of the ozempic shortages. Speaker 0 00:09:41 My way of doing this is by reading out some of the responses from the open box question that I received in my survey. I don't want to address each one individually as I feel that everybody deserves to have their voice heard without my comment. There are quite a few of them that I've selected that I suppose represented the majority views and I just thought it might be helpful for other patients to hear that they're not alone and to hear what other people are experiencing. Also, it's also quite important for pharmacists and healthcare providers to hear their patient's voice and to hear the reality of how they actually feel about the shortages of ozempic. As I can't get the medication, my weight has increased, my mood is low, and my mental health is definitely suffering cause of it. Even when the chemist told me that they could give me two of the 0.5 milligrams instead of my normal one milligram, I was advised that the HSE would not pay for two injections and so I'd have to pay for one privately. Ozempic should be available on the drugs payment scheme for weight loss. I had some difficulty When I started late in 2022, the pharmacist attitude was the problem, the way I see it, if my doctor prescribes it, then the pharmacist fills the prescription end of a lecture in the shop on why it's in short supply and asking why I was taking it is unnecessary in my opinion. I do see a place for pharmacists in healthcare. I've just left that shop. Speaker 0 00:11:28 I was told the product was in stock when the prescription was dropped in. When I went back the next day, I was told, sorry, we can't dispense it. As diabetic patients get priority, it takes calling around all pharmacies to chase it up every single month. This is very stressful and very time consuming. Speaker 0 00:11:47 I have changed from ozempic back to Metformin as I'd missed too many doses of ozempic waiting on supply. Metformin isn't working as well as the ozempic. My blood sugars are rising again. I was two years on it and persevered through the terrible side effects and now I'm back at square one. For the past six months I've been on and off ozempic. I've gained weight and old habits are creeping in. I have to beg chemists to get it in my chemist where I get all my medication, it's a disgrace. I have diabetes, I need it, and a whole lot of it. I had to go a week without ozempic as I just couldn't source it anywhere. I had the sweats, lightheadedness and I felt quite unwell. Obesity is a disease. Ireland is preventing me from getting the medication that I need. It's the shame of being told no, we need to keep the stock for diabetic patients. Speaker 0 00:12:40 It's a tool to obese people who have struggled all their life to lose weight. It should be available. It's given me a lifeline to get me properly healthy for the first time in 20 years. Obviously it's upsetting simply because I'm prescribed it by an endocrinologist, but it's not available. I have other medical issues plus long-term illness, so while many of us tick the box for weight loss, it's a lot of other medical reasons too. Also cause of no supply. I've had to go back on a previous one, which didn't work. It just kept me even. I feel the light at the end of the tunnel has just become a pin prick again, nobody should need to know why you are on it or shame those who are asking for it. It's actually working for me as an adult. I'm finally the lightest. I've been probably since first year in secondary school and I'm still just under 15 stone at that. Speaker 0 00:13:28 I'm getting stressed because I can't do this without the stroke and putting on weight and putting weight back on is just not an option for me. Either that or I fly to Turkey for surgery. I have selected weight loss as the reason for taking ozempic because I'm not diabetic, but it's to help with insulin resistance due to P C O S. It's not just for weight loss and the pharmacies also make you feel shallow and pathetic for using it when not diabetic. To be quizzed and rejected from purchasing ozempic just adds further humiliation to an already stressful situation because of a shortage and supply. When I can't get ozempic, I start to panic and I feel that I can eat more as the days go by, which causes anxiety. Speaker 0 00:14:10 I'm using it for weight loss. I have P C O S and rheumatoid arthritis. I've stopped taking anti-inflammatory medications since weight loss and because I'm eating better, I have more energy. I also feel more motivated while I'm mono ozempic and this leads to feelings of accomplishment, which in turn leads to elevation of mood. I feel anxious and worried when I can't source medication as I don't want to go back to having no energy. I also feel ashamed and embarrassed begging for medication that has been prescribed leading to feelings of shame and guilt. I've had to shop around pharmacies in the area to get a supply in the early days of the shortage and I've had to try and get five or six doses out of a four dose syringe to ensure I had some in my system cuz I don't want to decline back to my old weight. Speaker 0 00:14:52 It's really stressful trying to decide whether Tremaine went one pharmacy in the hope you'll be sorted there or contact every pharmacy within miles. Then if you can't get it, you're trying to decide whether to ration or reduce your existing dose or remain on your prescribed dose until you have a gap and it's not pleasant for the pharmacist either. I'm ringing around pharmacy looking to see if I can find someone to fill my prescription. I feel like a drug dealer looking for a fix. My pharmacy won't give me ozempic anymore because I'm not diabetic. I was on it for nine months and now I can't get it. This is a difficult disease to deal with the loan without proper treatment and unfortunately we all know the impact of stress. I e cortisol overload. There is no cure, but there are treatments which help us to lead healthier and more fulfilling lives. Speaker 0 00:15:37 It really is distressing to have supply of a needed medication for health and not aesthetic reasons interrupted on a regular basis so to the guilt. Some patients have been made to feel when seeking it for the disease of obesity rather than diabetes. I had to move on to Saxenda, which is way more expensive. I didn't qualify for the drugs payment scheme as I wasn't diabetic or pre-diabetic even though I have A B M I of over 40 and other comorbidities as a result of my weight. My pharmacist asked if I was on it for weight loss or diabetes and said they're prioritizing supply for diabetic patients, but it's prescribed for me by my endocrinologist and it has reversed my pre-diabetes in high cholesterol due to the weight loss it's caused, which is over 25 kg. I was morbidly obese and I'm now only in the overweight category. Speaker 0 00:16:27 Our local pharmacies were unable to supply us with ozempic, so our GP prescribed us a much more expensive option of saxenda. Due to the lack of supply of ozempic, I've had to reduce my dosage to ensure the pen I have will cover any possible shortages. This in turn has affected my blood sugars and also my weight has increased and obviously this is a snowball effect onto my general health and mental health. As soon as I have to stop taking ozempic, my appetite returns with a vengeance and almost all of my weight loss has returned, which negatively impacts my blood pressure, sleep apnea, physical and mental health. My husband is also on it for diabetes and is in the same boat. My recommendation came from a weight management team in Locklin's Town where I receive ongoing treatment. I'm a borderline diabetic. I stopped getting ozempic in September last year. Speaker 0 00:17:19 I've put on two stones since I was on one milligram. I was at the weight management clinic in November and the doctor said that because I was so long off ozempic that I'd have to start the treatment all over again at the lower dose, so I started on 0.25 milligram per a month. Then the pharmacy couldn't get the 0.5 milligram so I was without ozempic. Again, this is called huge difficulties for me because instead of maintaining my weight and diabetes control, it has done the opposite. As I said before, I've gained a significant amount of weight. My hba one C levels have also risen slightly. Shortage of this medicine is stressful knowing that the pharmacy may not have it when you need it. I have not been able to get ozempic for two months and I've regained seven kg. Ozempic helps me to manage my obesity and it causes me high blood pressure and pre-diabetes. Ozempic helps me to manage my obesity. My obesity causes me high blood pressure and I'm pre-diabetic. There is no alternative treatment as the alternatives are in short supply too. This needs to be addressed as the treatment is absolutely essential to us. Speaker 0 00:18:26 I had to half my dose and then I had to go without it for a week. My blood sugars have been perfect for over a year and when this happened, they went off again and I felt nauseous too. It's stressful not knowing if you're going to get it or not, like the pharmacist doesn't keep anything aside for regular patients. Also, you kind of feel judged or something in the pharmacy getting it now. It's hard to describe. Speaker 0 00:18:51 It's clear that the shortages of ozempic are causing significant stress for all patient types prescribed ozempic. Some standout points from the responses include that stigma has no place in healthcare. Attitudes towards obesity need to change. It's not a lifestyle choice, it's a disease. I want to tell you that it's not easy being a pharmacist in this position either. Pharmacists are between Iraq and a hard place. Diabetes and weight loss are intrinsically linked. The higher your bmi, the higher your risk of developing type two diabetes. This is because the more excess weight you have, the more resistant to your muscle and tissue cells become to your own insulin. It is my view that obesity is one of the biggest threats we have to our failing health service. Failure to adequately and holistically support patients with obesity will cause a pharmacoeconomic crisis in our country. Half of the world's population will be overweight or obese within the next 12 years. Speaker 0 00:19:50 Childhood obesity is also protected to double by 2035 from 2020 levels by 2060, it's expected that over 88% of Irish people will be overweight or obese. The pharmacoeconomic threat is one aspect, but the societal and human factors are crushing. I'm upset to think of people who feel like they're trapped in a prison of a body. I am sad that this medicine shortage is happening. I don't have the answers. I just empathize with patients and my pharmacist peers who are struggling through this, and I wanted to add my strong view that GLP one analogs like Ozempic and Saxenda should be covered on the GMs and drugs payment scheme. It does not make financial sense to ignore Ireland's obesity crisis on either a societal, pharmacoeconomic, or human level. I'm currently reviewing data from a survey of over 270 Irish pharmacists and I feel it's important to highlight the reality and impact on Irish pharmacists like myself. Also, I'll bring this episode to you over the coming weeks. Thank you so much for listening and thank you to all of the Ozempic patients for taking the time to fill out my survey and to enable me to give you a voice.