The Next Drug Crisis May Be in Our Medicine Cabinets

NEWS | DRUGS

Written by Jamie Clumpas (he/any) | Contributing Writer

Drug use, alcohol, narcotics and addiction are often discussed issues in student media, and for good reason. But there’s another drug crisis that could hit our shores that has yet to take its fair share of airtime. 

It’s a crisis that’s emerging here and overseas. It could put millions of lives at risk, even from just scrapes or routine operations. It could make treating UTIs and STIs (the famous fresher special) substantially harder. And it’s got nothing to do with what the drugs do; it’s what they soon might not be able to do. 

Fight bacteria.

Act 1: Good Drugs Hunting

It’s almost far-fetched now to consider that people genuinely used to die from cuts, scrapes and minor surgical fuckups, but Alexander Fleming’s discovery of penicillin in 1928 ushered in a new era in modern medicine.

Yet, in his Nobel Prize acceptance speech, Fleming already warned that his miracle discovery could be ruined if we aren’t careful.

Bacteria, like all other living things, evolve; and some bacteria have naturally evolved to resist antibiotics. There’s numerous ways different bacteria actually become resistant to antibiotics; the specifics of these are far above the prerogative of this magazine.

The key issue is the introduction of antibiotics into an environment can effectively kill the competition for these so-called ‘superbugs’. While most bacteria die, resistant bugs get to take the resources in the environment and spawn countless newly-resistant clones to fill the void; these germs may even be capable of passing the resistance on to any new bacteria they find. The zealousness of mid-century doctors to prescribe antibiotics for next-to-any illness did no favours in slowing down the progress of resistant bacteria.

Luckily, this wasn’t too much of an issue for us industrious little capitalists in the mid twentieth century. If you were a pharmaceutical company in the ‘50s, you could pump out countless new antibiotic variants and be sure that health agencies would be keener to get their hands on them than guys in suits are keen to get into law lectures. But as time went on, the antibiotic compounds we were discovering became more and more specific, targeting smaller ranges of bacteria. If early antibiotics were sledgehammers, newer strains were more like twigs; and it’s hard to make money selling twigs.

As the new drugs got less broadly effective, less were sold; not just because the drugs were simply less applicable to as many conditions, but also because doctors finally realised blindly throwing antibiotics at anything probably wasn’t helping.

The profit motive of big pharma essentially trapped us in a feedback loop. Concern over resistance reduced the net demand for antibiotics, which disinsentivised research on new antibiotics, which only increased the concern for resistance. Since 1987, precisely zero new antibiotic families have been found, and we now live in a time known only as “the discovery void”...

Act 2: Journey to the Centre of the Void

The continued rise in resistance and the fall-off in drug development is already causing problems The WHO was clear in a 2014 report that “this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country.”

Dr Bryan Betty, Chairman of General Practice NZ, spoke on the AM show in early March, warning that health professionals have been seeing an increasingly prevalent amount of antibiotic resistant infections in Aotearoa. In particular concern to the demographic of this magazine, UTIs & STIs, are rapidly becoming more resistant to antibiotic treatments. Now one of our most commonly used anti-UTI drugs is basically ineffective.

Dr Betty also warned that gonorrhoea has developed resistance to all but one known antibiotic, and around the world cases with total resistance are rising. Gonorrhoea can cause chronic genital pain, infertility and infections in newborns, so to put it mildly, resistance in this STI is concerning.

Around 4.5 million people annually die from resistant superbugs, however that number is expected to surge to 10 million within two decades if we cannot get this under control.

So, what next?

Act 3: Eternal Crisis of the Drugless Time

Humanity’s collaborative effort to completely fuck modern medicine may well succeed if we don’t change course.

An easy step anyone can take to discourage resistant bacteria is simply to follow the instructions when prescribed antibiotics. A curtailed course can purge weaker bugs, but let more resilient bugs survive and reproduce. As much as it may seem trivial, finishing that prescription could potentially save a lot of pain in the future.

While Aotearoa now maintains some of the strictest rules and regulations on prescription, some other countries, particularly in the developing world, have yet to follow our stride. A massive medical culture shift is required in these places if we hope to get on top of the crisis, but it’s very possible; after all that is exactly what has happened here.

Pivoting away from a volume-based profit model in pharmacology to a system that still rewards the creation of new antibiotics may help us out of the void. In the UK, a system where developers are paid a licensing fee for their drugs to be used by the National Health System, regardless of overall production, has seen some success in encouraging the development of more antibiotic drugs.

Ultimately, these solutions are to fight the fire, not prevent it. The single best way to discourage resistance in illness is to prevent the transmission of them in the first place. Healthy warm homes, affordable healthy diets and better preventative health are some of the best tools we have to fight the antibiotic crisis, and while a lot of our solutions rely mainly on hope, these things are almost painfully simple. 

While this crisis is looming, all it takes is a bit of political will to protect this medical miracle for future generations.