I rely on pills to prevent psychosis. Coronavirus is disrupting medication supply lines — and I'm terrified

A friend whose usual co-payment for antidepressants was 90 cents was recently told by his pharmacist to pay $159

US pharmacies rarely will tell you ahead of time what they're going to charge for medication (Agence France-Presse/AFP via Get)

A few months before the start of the coronavirus pandemic, in fall of 2019, I went into psychosis. I am bipolar. On the advice of my doctors, I‘d switched from my antipsychotic Seroquel to another drug. Soon I heard voices muttering nonsense, through windows, out of trees. I teach, and I found myself suspended in front of the computer in my classroom, unable to log in. I had lost any sense of what the login bar even was. It hung there like nothing I’d ever seen, a postal slot to the void. I remained psychotic for weeks, on medical leave from work, isolated.

When the virus struck, I grieved for the ill and worried about those close to me. For myself, though, reading the many news stories about prescription shortages, my fears concerned losing my prescription drugs. I’d learned only one medication kept me stable. I also knew the US drug supply is vulnerable at the best of times. Eighty to ninety percent of the base materials for our pharmaceuticals come from overseas, mostly from China. Many of these go to India to be formulated. Generic drugs are particularly likely to come from overseas. As these countries shut in, or slowed down, due to the virus, medication supply stood at risk.

Here’s an example of a normal shortage. A friend who takes the antidepressant venlafaxine went to pick up his one-month prescription, a prescription that had always had a copayment of 91 cents. This time, the pharmacist blandly requested $159. When my friend asked how the cost could have gone up so much, the pharmacist checked her computer and said that tablet versions of the drug—though identical in action to the capsules he’d been taking—were in an “upper tier” and more costly. The capsules were out of stock, she said. And that was that, besides the hand-over-your-credit card part.

My prescription panic soon turned into wake-up-in-the-middle-of-the-night, tears-when-I-took-my-daily-doses-out-of-their-tan-bottles panic. The CDC recommended getting a ninety-day supply of essential medication; insurance would only cover thirty. Without insurance, the extra two months would cost a significant amount. I can’t tell you just how much because pharmacies charge wildly varying prices for prescription drugs and are not obligated to — and mostly won’t — tell you ahead of time what they’re going to charge.

Generic Seroquel, 300 milligrams, can cost anywhere between $160 to almost $600 for a thirty-day supply. I also need a 25-milligram dose of Seroquel, lamotrigine, alprazolam, and gabapentin. Prices depend on the pharmacies having in stock the cheapest versions of the drug — generics. Even in times of regular supply, they may not.

Rosemary Gibson, a fellow at the Hastings Institute and author of China Rx: Exposing the Risks of America’s Dependence on China for Medicine, tells me medication supply “is a fragile system,” rife with shortages like my friend’s, even without coronavirus. We rely on countries whose politics, economies, and social situations are beyond our control. “There’s no doubt that there is a drug squeeze due to coronavirus,” Gibson says. “Multiple sources have told me that supplies are on allocation, which means rationing.”

Gibson tells me it’s hard to predict what medications exactly might be at risk in the long term, as there is little transparency. Pharmaceutical companies’ supply chains are considered trade secrets. Antidepressants are at risk, as many come from India. Soon many people may be paying hundreds of dollars for their venlafaxine, even as those who need psychiatric medication are likelier to live in poverty.

My insurance company relented in the wake of shelter-in-place orders and agreed to cover up to six months’ worth of prescriptions. I’m fine, for several months at least. I’m aware that the most urgent supply problems right now are shortages of essentials like painkillers and antibiotics.

Still, my anxiety and my situation have led to an odd déjà vu. When I was a teenager, I used a great deal of heroin. While I finally overcame my dependence on it, today I am reliving that need, or the fear behind that need. When you take your drug of choice and a little of the high goes away, in comes that voice, the one that whispers you may never feel this good again. It’s hit me hard that I’m again unable to function without shoveling foreign substances into my body. I am dependent again, in a way the virus has brought into focus.

I remember myself as that girl who needed a high, crouching on the sidewalk. I called to people, hand outstretched, begging. The people who streamed by curved outward around me like a bend in a river — as when I returned to work after my psychosis and coworkers bent away from me in hallways, suddenly hugging the wall. I want to stay well like you, I’d like to say to all of them. But there are no guarantees.

Susanne Paola Antonetta is an author and member of the Economic Hardship Reporting Project