Fears for schizophrenia patients after anti-psychotic drug olanzapine hit by supply crunch

Pharmac says it understands the urgency and importance of the olanzapine medication.

Officials at Health NZ and Pharmac are scrambling to resolve a shortage of supplies of long-acting olanzapine injections prescribed to people with schizophrenia. Alex Spence reports that psychiatrists are concerned some of their patients could experience a relapse of psychotic symptoms.

Psychiatrists have raised fears for the safety and wellbeing of hundreds of patients with severe mental illness after a global shortage disrupted the supply of a vital antipsychotic medication.

Officials at Health NZ and Pharmac have been meeting weekly to resolve an urgent supply crunch of a form of the drug olanzapine that is typically used to manage symptoms of schizophrenia, such as hallucinations, delusions, and disordered thinking.

Around 1000 people are prescribed the highest dose of Zyprexa Relprevv, a slow-release “depot” injection that is administered monthly. Clinicians at Health NZ said their treatment, already subject to a prolonged supply squeeze, had been thrown further into uncertainty when a crucial shipment did not arrive in New Zealand last month.

Psychiatrists were told to urgently review their caseloads and consider alternatives for their patients, such as switching them to lower but more frequent doses of olanzapine depot injections or moving them to other antipsychotic drugs.

Doctors said patients receiving 405mg doses of Zyprexa Relprevv include some of the most vulnerable people in the mental health system — a disproportionate number of whom are Māori and Pasifika — and that any disruption to their medication could be stressful and damaging. In many cases, those patients have difficult living circumstances or limited insight into their illnesses, which can make changing routines extremely challenging.

The psychiatrists say their major concern is that some patients could experience a relapse of psychotic symptoms, which would be distressing for them and their families and could require hospital admissions at a time when psychiatric units are already crowded beyond capacity.

“To take these medications in the first place, one has to be experiencing a mental health problem that is significant — usually psychosis — and the illnesses themselves are very stressful for tāngata whaiora and whānau,” said Dr Hiran Thabrew, NZ chair of the Royal Australian & New Zealand College of Psychiatrists.

“Unexpected medication changes certainly are stressful for them, but also for clinicians.

“We certainly hear from our workforce that these changes have caused confusion and a lot of extra work for clinicians who are already under the pump,” Thabrew said.

Adrienne Martin, acting director of pharmaceuticals at Pharmac, said: “We are very aware of the importance of this treatment. We have been working closely with Health NZ to manage the situation. And we have been taking every measure we can to ensure that people can continue to access this treatment.”

Zyprexa Relprevv is one of several drugs that have been harder to get in New Zealand recently because of supply problems caused by the Covid-19 pandemic, conflicts in Ukraine and the Middle East, and other overseas events.

Have you been affected by drug shortages? Contact the reporter at alex.spence@nzme.co.nz

Pharmac says it was first notified midway through last year that supplies of all doses of the Zyprexa Relprevv depot injections — manufactured by Eli Lilly and distributed internationally by a German company called Cheplapharm — were scarce because of shortages of the main active ingredient.

Stocks of the depot injections have been tightly allocated and only given to patients already prescribed them. (Around 2400 people received olanzapine depot injections in the last financial year.) With little in reserve, a delayed shipment “creates an immediate supply issue”, Martin said.

A shipment of the 405mg dose was expected in February but delayed until early March. Then it was delayed again, prompting the instruction from Health NZ to psychiatrists to urgently devise alternative treatment plans for those patients.

Pharmac said it expects the shipment of 405mg injections to arrive this week.

But psychiatrists have been told to expect restrictions to supplies of olanzapine depot injections to continue for the rest of the year.

Murray Patton, clinical lead for specialist mental health and addictions at Health NZ, said the health service recognises the uncertainty the supply problems have created for psychiatrists and patients and is working with Pharmac to lessen the impact.

Pharmac has agreed to fund another antipsychotic, aripiprazole, as an alternative, but clinicians say it will not be effective for all patients who have been receiving olanzapine depot injections.

Supplies of lower-dose olanzapine forms taken orally have not been affected by the supply issues.

Pharmaco, which represents Cheplapharm locally, said: “We appreciate the importance and urgency of maintaining a regular supply of Zyprexa to patients in New Zealand. This is a global issue, and we are working hard to do what we can to ensure that NZ is provided for so that the patients who depend on this medication can obtain what they need.”

Alex Spence is an investigative reporter and feature writer who focuses on social issues. He joined the Herald in 2020 after 17 years in London where he worked for The Times, Politico, and BuzzFeed News. He can be reached at alex.spence@nzme.co.nz or by text or secure Signal messaging on 0272358834.

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