Here’s a bitter pill to swallow. Back in January there were, according to the Therapeutic Goods Administration, 261 medicines affected by shortages.

Some of these shortages, according to a report at NewsGP, were due to an unexpected lift in consumer demand – and it’s perhaps telling that these included Diazepam (used to treat anxiety, alcohol withdrawal and seizures), Gabapentin (an anticonvulsant) and Omeprazole (heartburn and indigestion).

If that’s not a portrait of a nation biting its fingernails, then what is?

Of the 31 critical shortages named by the TGA – meaning they were unavailable – most were injectable steroids, antibiotics and anaesthetic agents.

Too reliant on manufacturers offshore

NewsGP noted that these were similar to the shortages seen overseas, which is especially troubling because Australia imports 90 per cent of its pharmaceuticals from overseas.

What’s going on? Australia has always been vulnerable to shortages, but that vulnerability has been severely tested by the COVID-19 pandemic.

The severity of Chinese lockdowns and interruptions to manufacturing is just one factor.

And, of course, there’s the damn war.

But there are oddball factors also at play.

So we reported in June that the diabetes drug Semaglutide, marketed under the brand name Ozempic, was running short because it had become a popular treatment for weight loss.

The TGA quietly issued a statement, directed at GPs, urging them to stop prescribing the drug for obesity management.

The story only broke open because hundreds of people were going on TikTok to not only show off their slimming bodies, but to inject themselves with the drug as a form of Pulp Fiction-esque performance art.

So how are we doing now?

As of Thursday, the TGA listed 340 drugs we’re running short of – significantly more than January – and included 39 critical shortages.

On top of this, the TGA said shortages of an additional 83 drugs was anticipated.

The shortages are largely managed by doctors prescribing similar drugs – which isn’t always satisfactory and can be problematic – or when regulated substitutes aren’t available, the TGA has approved ‘‘unregistered’’ products under Section 19A, a move taken ‘‘in the interests of public health’’.

Last  month, NewsGP ran another report, calling the situation ‘‘not sustainable’’.

RACGP Victoria chair Dr Anita Muñoz told the site that ‘‘changing medications increases the likelihood of mistakes and urged for as much action as possible to ease the disruptions’’.

She said: ‘‘Chopping and changing and making last-minute changes can confuse patients, and only increases the chances that medication misadventure will happen.

‘‘We really cannot rely on this as a strategy.’’

Sometimes, there is no substitute

On Thursday I called a friend who works as a rural doctor. I often call him for background on a news story and he asks that I refrain from using his name.

About two weeks ago this GP received an email advising that the ADHD drug Ritalin wasn’t available.

‘‘We get these sorts of emails like this all the time … from the TGA or the National Prescribing Service, but this was the big one,’’ he said.

‘‘Just about every kid with attention-deficit/hyperactivity disorder is on Ritalin.’’

The email advised doctors ‘‘to try and find some substitute’’.

But Ritalin is a unique drug. There is no real substitute and ADHD kids are ‘‘very difficult to control behaviourally anyway’’.

He said Ritalin was the most effective drug for the condition ‘‘and anything else that you give them, which is usually an anti-depressant or a behaviour modifying drug, it’s never as good’’.

This doctor works in Ballarat. When parents come to see him and have accurately discerned that their child has ADHD, he advises them that ADHD can only be formally diagnosed by a paediatrician or psychiatrist and there is a six-month wait for any kind of specialist.

‘‘On top of that I’m now saying, well, yes, your child needs Ritalin, but GPs are not allowed to prescribe Ritalin –  and there isn’t any available at the moment anyway.’’