A few weeks ago, a family member called our pharmacy for a repeat of a prescription she has been on for many years. The medication is necessary, to keep at bay, symptoms from a chronic gastro-intestinal illness. To our surprise, the pharmacist informed us that the medication was on “back-order” and would not be available for about a month. Phone calls to several other pharmacies corroborated the unavailability of the drug. Ultimately, an alternate, but less specific and less effective drug was prescribed. Our pharmacist, calling the supplier almost daily, eventually found one bottle of the medication.
The issue of prescription drug shortages is not new, and has been accelerating for about two years now. “What’s changed is that for the past year and half or so, the intensity and the number of shortages that are occurring and the length of the shortage has really been almost unprecedented” says Jeff Morrison, director of government relations for the Canadian Pharmacists Association.1
There are many purported causes for the shortages: including shortage of substrate, growing demand for drugs globally, quality control breakdowns, unexpected increasing demands for a particular drug, and accusations that pharmacies are preferentially stocking drugs with a high profit margin. In fact, “the FDA says the shortages are primarily a result of manufacturing deficiencies that lead to production shutdowns. They are also caused by companies that end production of drugs that have small profit margins, consolidation in the generic drug industry, and not enough supplies of some ingredients”.2 In fact, our own Dr. Jackie Duffin, Queen’s Hannah Professor of the History of Medicine and a hematologist, has devoted a website to this issue, providing useful information to Canadian patients.3
Dr. Paula Rochon, a senior scientist at Women’s College Hospital, said doctors and other clinicians need to be part of the solution.4 She argues that the problem is not exclusively the responsibility of the pharmaceutical industry or clinical pharmacies, but rather a collective problem for government, industry and health professionals.
This is also an issue for both our federal and provincial governments, with at least our province of Ontario arguing that we need further federal oversight of this issue. In fact, Ontario’s health minister Deb Matthews has been quoted as criticizing the federal government for not legislating that impending shortages need to be widely disseminated; “It is still a voluntary notice, so that just isn’t good enough,” Ms. Matthews said.6 Currently Health Canada encourages manufacturers to report any current or anticipated shortages to an online database.7
This is an important issue, which will need the involvement of patient advocacy groups, industry, and health professionals to solve. Drug shortages are a real and serious issue for Canadians, and this problem has reached proportions that mandate ramped up action and a greater public focus.
If you have any views on this issue, respond to this blog, or better yet…please stop by the Macklem House, my door is always open.