The Texas Pharmacy Board is weaving in and out of its lane.

Tarrant County pharmacists, “at the directive of the Texas Pharmacy Board,” are blocking physicians from prescribing hydroxychloroquine, mefloquine or azithromycin — drugs that could be useful against COVID-19.

That’s even though the president, the governor and the board itself has said it’s OK.

The board’s ruling reads that it “does not prevent a physician from prescribing one of these drugs for an off-label use.” The intent, it says, is “to prevent the stockpiling of the drugs and to ensure that reasonable quantities are available for all patients.”

But a rumor exists that it can only be used consistent with evidence for its use, and no one can find a pharmacy board ruling to that effect. Many area pharmacists are concluding this drug can only be used for arthritis, lupus, and urticaria. They are wrong.

In a phone survey last week, more than half of those contacted would not allow off-label prescription.

I spent hours on the phone trying to get hydroxychloroquine — not for use, but as a backup for the fever spike that signals coronavirus. One pharmacist pleaded with me to get something in writing,

“I have a good supply of these and I really want to use them, but I can’t,” he told me. And he wasn’t the only one.

Off-label prescribing usually puts only the doctor at risk for litigation, but pharmacists who would comment said they would not allow it because of risk to their licensure by the Texas Pharmacy Board.

Off-label use of medication is common and legal. Consider the most common drug used to treat asthma, albuterol.

Discovered in 1966, it was not approved for children younger than 12 with asthma. We used it off label before it became approved years later and didn’t regret it then or now.

How about Gabapentin? Originally approved as an anti-convulsant, its effects led doctors to use it for everything from shingles to neurological pain.

Even the old antihistamine Benadryl began its life in an off-label use in 1937 as a way to calm combative prisoners in French prisons.

Pharmacists should know of a national law called “right to try.” It allows people to ask for an unapproved therapy. Federal law trumps state.

Why do doctors demand this right? Most have a list of patients who are hanging by a thread at home, with conditions such as heart failure, kidney failure or terrible chronic obstructive pulmonary disease. We do our best to isolate them.

One of my most serious patients is married to a nurse anesthesiologist. We are all worried about her, as we are about spouses of essential people like hospital workers, clerks, doctors, nurses, and the many others who serve us on a daily basis.

The stated intent of the board is to protect the supply of hydroxychloroquine. Doctors understand and agree. But there is absolutely no shortage of this medication, either in pharmacies or hospitals.

We don’t need to save millions of tablets for the few people who are currently hospitalized in Tarrant County. We want only 14 tablets for these very high-risk patients if they spike a fever, not after they are on a ventilator, when the survival rate is poor.

Ask yourself: If your mother or father or even a child is high-risk, would you accept this drug if a doctor suggested it? For me the answer is a resounding “yes.”

But it’s an ethical issue, and the pharmacy board has not returned phone calls.

Gov. Ann Richards once quipped, “Once you get past ethics, the rest is easy.” Of course, she was referring to a legislative agenda in which a controversial ethics bill threatened to stall lawmakers’ session. But its unintended meaning has been more useful over time.

It’s time for pharmacists to man up. You are not going to lose your license on this one.

This story was originally published April 21, 2020 at 7:04 AM.