One in five drugs out of stock

In 2023, nearly 3,000 drug shortages have been reported in Canada. Or more than 20% of products approved in the country, reveal data obtained by The Press.

“Canada has been experiencing constant shortages for 10 years. It’s really unbelievable. It’s surreal to see the quantity of products that constantly become in critical situation and fall into shortage,” says Jean-François Bussières, clinical professor at the faculty of pharmacy at the University of Montreal and former head of the pharmacy department of the CHU Sainte-Justine.

As of December 29, 2,975 drug shortages had been reported in Canada in 2023. Whereas in the past, we had to deal with occasional drug shortages, these now pose a daily challenge, underlines Mr. Bussières.

From 2017 to today, 1,878 of the 9,343 prescription drugs sold were hit by a shortage on average each year, according to Health Canada data obtained by The Press. That’s more than one in five medications.

No less than 20% of a pharmacist’s working time is devoted to managing drug shortages, according to the Canadian Pharmacists Association. This involves informing patients and health teams, finding new sources of supply and developing alternative solutions. “We make sure to minimize the impacts. It’s not visible, but it’s a lot of work,” says the head of the pharmacy department of the CISSS de la Montérégie-Est, Diem Vo.

Thousands of shortages

“There are a lot of shortages, all the time. The pandemic has really highlighted the fragility of the supply chain,” says Geneviève Pelletier, senior director, pharmaceutical service, at the Quebec Association of Pharmacist Owners.

The average duration of each shortage reached 98 days in 2022-2023, or more than three months, according to Health Canada data.

These supply interruptions exert considerable pressure on the health network. An information bulletin is sent twice a month to health establishments in Quebec to notify them of medications affected by supply difficulties. “In 2021, we had a three or four page document. We now have a document of approximately 15 pages. There are more and more of them and they are more and more worrying and critical for customers,” says the president of the Executive Committee for Pharmaceutical Acquisitions (CEAP) of the Table of Heads of Pharmacy Departments, Diem Vo.

What’s more, some are concerned to see American authorities allow certain states to import drugs south of the border, starting with Florida which received the green light on Friday.

“Canada simply cannot provide drugs to Florida, or any other American state, without significantly increasing the risk and severity of drug shortages in the country,” the interim president of Innovative Medicines Canada, an interest group representing pharmaceutical companies, David Renwick.

For his part, the federal Minister of Health, Mark Holland, wanted to be reassuring. “I want to ensure [aux Canadiens] that they will continue to have access to the medicines they need, when they need them,” he said, adding that “strict regulations to protect the supply” are in place.

Health Canada subsequently clarified that regulations have been implemented under the Food and Drugs Act to “prohibit the sale of certain drugs intended for the Canadian market for consumption abroad if such sale risks causing or aggravating a drug shortage in Canada.” “Bulk importation will not be an effective solution to the problem of high drug prices in the United States,” the Department also said.

Impacts for the population

Mathé-Manuel Daigneault despite himself must deal with the consequences of the recurring shortage of injectable testosterone, a treatment used by many trans men.

“I’ve been taking it for almost 10 years and I’ve lost count of the number of stock outs I’ve experienced during that time,” he confides. Some of the worst shortages in recent years have stretched over several months.

These shortages involve switching from one type of testosterone to another. “However, some people react badly to one of the two solutions,” he says. This is his case. He is allergic to one of the two products available. It is not uncommon for a shortage of one to be quickly followed by a shortage of the other, fueled by an increase in demand.

“There is definitely the option of freezing or [timbres]but their price is much higher, not to mention the need to apply the gel daily and the risks of transmitting the dose to anyone with whom we have skin-to-skin contact in the hours following application,” says- he.

Looking for alternatives

Behind the scenes, pharmacists strive to mitigate the repercussions on the population, in particular by ensuring close follow-up with suppliers. They must also “help patients find [solutions de rechange] and manage their concerns,” says M^me Pelletier.

When there are no alternatives, pharmacists sometimes have to contact Health Canada or the poison control center to change the expiration date of medications until restocking or the arrival of an alternative solution, explains Diem Vo .

Drug shortages can also result in additional costs. Substitution treatments are sometimes more expensive, thus increasing the bill both for patients and for the Régie de l’assurance santé du Québec (RAMQ), explains the general director of the Quebec Association of Pharmacy Distributors (AQDP), Hugues Mousseau.

Carole Chapdelaine has been facing this reality since September. The 4 mg Ozempic pen she uses every month is out of stock. She is therefore obliged to purchase two 2 mg pens for the same period. Since the pens were the same price regardless of the dose, the cost of his treatment increased from $238 per month to $476 per month. “I am outraged that the pharmaceutical company is profiting from the shortage it is causing. It’s shameful,” she laments.

With the collaboration of Vincent Larin, The Press