Business Forum | Quebec, a dunce in the distribution of basic treatments and drugs

Our healthcare sector is sick. All the players, governments, manufacturers and patients are struggling to find their way around. The system fails to develop a real ER alternative for minor health issues as the pharmaceutical industry struggles to restore battered global supply chains and weathers drug price tensions original and generic in the face of governments^⁠1.

The latter are eager for low-cost drugs, without us having yet seen the tangible benefits of these savings on the efficiency of our health system. Worse, it does not seem to solve the fundamental problems of a system where the patient’s journey too often begins with an interminable visit to the emergency room and ends with a hasty 10-minute medical consultation and a prescription.

For the general public, alternatives to overflowing emergency rooms are too rare, and there have long been noticeable shortcomings in triage and referral of patients to the appropriate service. In addition, there are chronic deficiencies in the availability of treatment and medication for minor health problems and basic care. And it gets more complicated during shortages like the most recent, that of children’s medicines that are very useful to parents trying to treat their children at home.

However, solutions to unclog the health care system, although partial, exist and are implemented elsewhere in Canada and the United States.

One of these solutions is to promote greater availability of over-the-counter drugs in pharmacies.

Recent studies and initiatives testify to this solution for keeping patients struggling with minor ailments away from the emergency room. Essentially, this involves working with the pharmaceutical industry to move certain products from the Rx counter (requiring a prescription) to the pharmacy shelves where the drugs are dispensed and accessible to patients.

An oft-cited study, that of the Conference Board of Canada^⁠2, presents the benefits of these decisions for the patient and our health system, and especially in the field of digestive health. Obviously, each initiative putting a drug on the counter must be accompanied beforehand by rigorous studies on the education required to manage the risks for the patient as well as for the fair distribution of the economic benefits between the actors (government, private insurance, pharmacists , patient, pharmaceutical industry).

However, and contrary to its neighbours, Quebec adopts a relatively cold position in the face of this possibility of promoting the empowerment of patients/citizens with a consequent decongestion of the health system.

This is how products like Nexium, Gravol products and other products like Nasacort and Flonase are sold over the counter in Ontario while they are kept behind the counter in Quebec, difficult to access and out of sight of the consumer patient. To the south, the United States is even more advanced in several respects, not hesitating to face controversy by authorizing the distribution of the abortion pill in pharmacies^⁠3.

Isn’t it curious that our provincial government monopolizes the sale of cannabis and alcohol products, with a no-nonsense even leading to a loyalty program stimulating consumption through “SAQ inspire”, while takes such a timid approach when it comes to making drugs available for temporary and minor health problems?

In the same vein, another project to unclog our health system consists in giving more latitude to the pharmacist in the prescription of drugs. Ontario has just innovated in this regard^⁠4 and authorizes the pharmacist to prescribe drugs covering a broad spectrum of common ailments, but requiring rapid treatment, such as impetigo, urinary tract infections, rhinitis, conjunctivitis and dermatitis. British Columbia and Alberta have also made similar decisions.

And Quebec? When will there be a concerted and enlightened approach to allow citizens to take care of their little ailments independently or with the help of their local pharmacist, who will be given the authority and resources necessary to provide these services? It is not enough to shout “avoid emergencies”. We must propose concrete options, demonstrate leadership by soliciting input from all the key players in the community.

2. Isabelle Gagnon-Arpin, Value of Consumer Health Products: The Impact of Switching Prescription Medications to Over-the-CounterOttawa: The Conference Board of Canada, 2017