By Taylor Knopf and Yen Duong
As North Carolinians scramble to collect water, bread and canned goods ahead of Hurricane Florence, it’s important to refill medications as well.
State and medical officials are urging residents to stock up “extra” medications for “several days.” It’s difficult to say how long the rains and winds will last, and even more challenging to predict how long the cleanup process could take.
Ibad Khan, a pharmacist with the federal Centers for Disease Control and Prevention, suggests making a medical emergency kit in preparation for a natural disaster and double checking that it’s up to date with your family’s medical needs. In a CDC blog, Khan lists 10 things to remember:
- Make a list. Keep a list of all your medications and the dosages in your emergency kit. Make sure you have the phone numbers for your doctors and pharmacies.
- Have your cards. Keep your health insurance or prescription drug card with you at all times so your pharmacy benefits provider or health insurance plan can help you replace any medication that was lost or damaged in a disaster.
- Keep a record. Make copies of your current prescriptions and keep them in your emergency kit and/or go bag. You can also scan and email yourself copies, or save them in the cloud. If you can’t reach your regular doctor or your usual pharmacy is not open, this written proof of your prescriptions make it much easier for another doctor to write you a refill.
- Start a stockpile. During and after a disaster you may not be able to get your prescriptions refilled. Make sure you have at least 7 – 10 days of your medications and other medical supplies. Refill your prescription as soon as you are able so you can set aside a few extra days’ worth in your emergency kit to get you through a disaster.
- Storage matters. Keep your medications in labeled, child-proof containers in a secure place that does not experience extreme temperature changes or humidity. Don’t forget to also include nonprescription medications you might need, including pain relievers, cold or allergy medications, and antacids.
- Rotate the date. Don’t let the medications in your emergency supply kit expire. Check the dates at least twice every year.
- Prioritize critical medicines. Certain medications are more important to your health and safety than others. Prioritize your medications, and make sure you plan to have the critical medications available during an emergency.
- Communicate a plan. Talk to your doctor about what you should do in case you run out of a medication during an emergency. If you have a child who takes a prescription medication, talk to their daycare provider or school about a plan in case of an emergency.
- Plan ahead. Make sure you know the shelf life and optimal storage temperature for your prescriptions, because some medications and supplies cannot be safely stored for long periods of time at room temperature. If you take a medication that needs to be refrigerated or requires electronic equipment plan ahead for temporary storage and administration in an emergency situation.
- Check before using. Before using the medication in your emergency kit, check to make sure the look or smell hasn’t changed. If you are unsure about its safety, contact a pharmacist or healthcare provider before using.
Source: Centers for Disease Control and Prevention
Medication storage
Storing medication such as insulin during a natural disaster can be tricky. Ideally, insulin should be refrigerated and kept between 36 and 46 degrees Fahrenheit, according to the Food and Drug Administration.
But when the power goes out, as it’s likely to do after Florence hits, patients may not have that option.
According to the FDA, insulin contained in its original, manufacturer-supplied vials or cartridges can be left unrefrigerated in temperatures of up to 86 degrees Fahrenheit — opened or unopened — for up to 28 days and still work.
However, if insulin has been altered in any way, patients should discard it within two weeks, says the FDA.
When exposed to extreme heat, insulin begins to lose its effectiveness. To keep it as cool as possible without refrigeration, store insulin away from heat sources and out of sunlight. If you cool it using ice, do not let the insulin freeze. The FDA warns not to use insulin that has been frozen.
To learn more about different types of insulin that may be available to you in an emergency situation visit the FDA website.
Elizabeth Hudgins from the North Carolina Pediatric Society said many physicians also worry about refrigeration – primarily for their vaccine stockpiles.
“So if people can go in and get vaccinated now, then that’s a fabulous place to store it, safely in your body, where it’s doing its work,” she said.
She said she was taking her son into his pediatrician’s office Tuesday afternoon to get a vaccination, only a little bit ahead of schedule.
“Stockpiling” medicine
While doctors recommend filling prescriptions early and keeping extra medications on hand for the hurricane, some who rely on controlled substances for pain relief find that impossible under North Carolina legislation.
“We cannot stockpile our medications in anticipation of the inavailability (sic) of and the inaccessibility to medical services post-hurricane impact day as we could back in 1996 [during Hurricane Fran],” Raleigh retiree Budd Nash wrote in a pain patient Facebook group this week. He gave North Carolina Health News permission to quote his post.
“Back then, we were encouraged to plan to have enough of the critical medications on hand to carry us through in case the hurricane made services unavailable,” Nash wrote. “But today, current laws prevent this. So what are we to do?”
With the current crackdown on opioid prescribing, accessing pain medications can be tough and even more complicated in the aftermath of a hurricane.
Another woman wrote on the same Facebook group that her prescription refill is due for Friday during the height of the storm. She tried to refill it early, but the pharmacist said she needs a doctor’s approval because it’s a controlled substance. Her doctor is out of town and unavailable.
One CDC administrator wrote in response to a pain patient that, “per Title 21 Code of Federal Regulations for controlled substances, prescriptions for schedule II controlled substances cannot be refilled and a new prescription must be issued. Prescriptions for schedules III and IV controlled substances may be refilled up to five times in six months. Prescriptions for schedule V controlled substances may be refilled as authorized by the practitioner.”
There are no easy answers for chronic pain patients, but everyone should contact their primary care doctors to discuss their medications, said Dr. Edward S. Kim with Atrium Health Levine Cancer Institute in a press conference.
“It’s very hard to prescribe very many [pain medications] because on one hand you can’t give patients the analgesia they need, especially if they’re cancer patients, but on the flip side I understand the regulations because there has been abuse,” Kim said. “We try to do our best with those patients. If they need more frequent follow-ups, they’ll have to use the emergency room as a resource. We try to keep in close contact with our patients, especially in times like this.”
Though pharmacies work as a network to keep patients supplied with the drugs they need, shortages can still occur, Kim said.
“The reason we run out of gas is not because of supply, but because there’s a surge of people wanting to fill up their tanks–the same goes for medications,” Kim said. “You won’t be hurting yourself by missing a few weeks of cholesterol medications, but if you have blood pressure issues or cancer medications or pain medications those are a little different.”
“Be thoughtful of what’s really essential versus what you can go for a week without. If you’re on 15 medications, probably they don’t all need to be filled tonight in preparation for this storm. If you’re not sure, talk to your [primary care doctor].”
Calling the doctor instead
If people are displaced by Florence or cannot reach their normal medical provider, telemedicine can fill the gap. Patients only need an internet connection to reach providers who can diagnose and treat sinus infections, urinary tract infections, allergies or minor issues via online apps. They can also get some prescriptions refilled.
People should go to urgent care centers or the emergency room for more significant issues.
“Certainly the virtual platform is an opportunity to refill blood pressure medications, cholesterol medications,” Dr. David Cosenza, specialty medical director for virtual care with Atrium Health, said in a press conference.
“In North Carolina controls are not refillable on the virtual platform. … [During] Hurricane Harvey, the state of Texas lifted restrictions on virtual care, but they got 60 inches of rain, and we haven’t seen that forecast here.”
Virtual medicine visits average about $49 per visit. You don’t need to be a current patient with Atrium to use their app but they do encourage you to download it before the hurricane and pre-enroll. The same goes for other telehealth providers.
Vidant Health, which has facilities and patients throughout the eastern part of the state, also has a telehealth urgent care service.
“If people need to see their provider and are not critically ill… we encourage them to use our virtual care, for as long as we have access to the internet and can do that, patients can go online and see a physician online 24/7,” said Vidant Medical Center president Brian Floyd, who also serves as chief operating officer for Vidant Health hospitals.
Vidant has also developed community partnerships that allow community members to call in and get connected to resources such as shelters and food pantries, as well as medical help.
“If they dial in and say, my oxygen tank is running out, then we know where the resources are, both county and our resources, and we know how to get people what they need,” Floyd said.
“People need to get creative as to alternative ways to provide care when a disaster hits,” Cosenza said.
“The aftermath [of the hurricane] may be the more challenging piece when providers may be available but have no place, or patients may be displaced and have no provider. … The reality is this storm might be different for the Carolinas,” he continued. “If it stalls like predicted, what is the aftermath, nobody knows.”
To use Atrium Health virtual visits, call 855-438-0010 or visit the website to download the app and pre-enroll.
For virtual visits with Vidant Health providers, sign up for Vidant Now online, download the app or call 1 855 MyVidant.
UNC Urgent Care 24/7 also provides telehealth visits. Check it out online here or download the app.
In Greensboro, members of Cone Health’s heart failure unit were accompanying paramedics and visiting patients at home to ensure they have what they need in case of power failure or other problems.
Even Walgreens, the pharmacy chain, was gearing up. It texted regular customers a message Tuesday, “Here to help if you are impacted by Hurricane Florence,” with a link to locations of nearby pharmacies and their hours.
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