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.
Richard
1. http://www.huffingtonpost.ca/2012/02/21/canada-drug-shortage_n_1292280.html
2. http://www.forbes.com/sites/dougschoen/2012/02/13/the-drug-shortage-crisis-in-america/
3. http://www.canadadrugshortage.com/
5. http://www.hivehealthmedia.com/drugs-shortage-pharmacies-rectified/
As a pharmacologist, I’ve been keeping a tab on a variety of drug-related issues that should be in the medical curriculum. Until a couple of years ago, the problem that garnered the most ink was drug toxicity, usually related to dosages that were inappropriate for the individual. Since adverse effects of drugs are responsible for about 10% of hospital admissions, I’ve been nagging students and our undergraduate dean as the occasion arises. A longstanding adverse effect of drug therapy has been inadequate dosage, usually attributable to poor patient compliance. It’s only recently that we have had to add “drug shortage” as a reason; this is probably the most preventable problem.
Now that the CBC and individual patients are starting bring this problem to the attention of politicians, we may get some action. At least there is some hope now. Our own Jackie Duffin has been a tower of strength in agitating for government and industry action, and deserves all the help we can give her.
Thanks Kanji. Your perspective is important. I agree with our luck in having Jackie as an advocate.
Richard
Dear Dr. Reznick -
Thank you for highlighting this important issue. This is a problem I virtually never encountered in my first several decades of practice, but in the last few years it has become an unpleasant and frustrating periodic reality, with potentially serious consequences.
Among other examples, within a short space of time two of my patients who suffer from chronic schizophrenia (with residual symptoms but doing relatively well) had their mental stability suddenly and unexpectedly threatened by an unannounced unavailability of their antipsychotic medications. In both cases the drugs in question were older medications – quite effective, but I suspect the market share and profit margins are low. In psychiatry as in other fields, people with hard-to-treat conditions may try numerous drugs and combinations before achieving response or possibly remission. Unfortunately, unlike changes in fashion or other consumer products, we can’t simply switch medications and expect the same effect. And when the unavailability occurs suddenly and without warning, perhaps even when the prescriber is away, there is the risk of serious decompensation and harm.
One local hospital responded this year by sending regular alerts to all staff as to the status of various medications from their formulary that were in short supply, with suggestions for substitutes when clinically appropriate, and updates as shortages eased again. However, the community practitioner who deals with many different drugs and pharmacies has no such coordinated system to rely upon.
Do you have suggestions as to how the average community-based health practitioner, without a political or administrative position, can practically ‘be part of the solution’, as Dr. Rochon suggested?
Thanks -
Beverly Goodwin, Meds ’87
Bev,
Thanks for responding with your experiences. I have had a suggestion that we consider hosting a forum o this issue. If it materializes, I will be sure to invite you as a participant. JAckie Duffin may have some other suggestions regarding other ways of getting involved.
Richard
Richard, glad you raised this issue. While I am not a Canadian, my wife and many relatives are. Fortunately, they and I have not yet had to cope with prescription drug shortages.
When a needed drug becomes unavailable for a family member (or oneself), it reminds us of how important modern medications are, wherever we live, for ongoing quality of life, perhaps even extended survival.
Thank you for urging greater public focus and ramped up action on this issue. I hope others will comment and suggest solutions, not blame what they think are the causes of needed-drug shortages or outages.
While I don’t have solutions, maybe some of your blog-followers will have feasible suggestions before needed-drug-unavailability becomes an urgent issue for one of their patients, a family member, or themselves, if it hasn’t already.
Dear Bill,
Thanks for your supportive comments and encouragement. It is, indeed a difficult issue, but one that clearly needs more focussed attention.
Richard
Our program devoted an entire show (our season opener) to the prescription drug shortage, in which Queen’s Jackie Duffin was featured prominently. . We’ll be repeating it over Thanksgiving with some updates. http://www.cbc.ca/whitecoat/drug-shortage/2012/09/04/the-drug-shortage-season-opener/
Dear Dawna,
Thanks so much for reminding us about your excellent program.
Richard