Calgary pharmacists worry drug shortages on the rise

Some Alberta pharmacists say they're worried about patients' health as they battle against what they describe as ever-growing drug shortages.

Health Canada started working with the provinces in 2012 when it launched a steering committee to study the issue. But local pharmacists say the problem is only getting worse.

"Shortages like this, I've never seen this bad, ever," said David Brewerton, pharmacy manager at Luke's Drug Mart in Calgary.

"It's progressively getting worse and worse and worse every year." 

Brewerton, who has worked for a pharmacy for nearly 40 years, says his daily drug shipments are about a quarter of the size they were last year.

The end result is a complicated juggling act involving searching for substitute medications, trying to source those in short supply and sending patients back to their family doctors or specialists to be re-assessed. 

According to Brewerton, it's taking a toll on patients, particularly those who have tried other drugs with no success.

"[When] they've finally found one that works — and you suddenly can't get it — well then you've got a real problem," he said.

Common drugs in short supply

There are also concerns about the kinds of drugs that are increasingly hard to come by.

While rare medications used to be the ones in short supply, pharmacists say some of the more common drugs — used to treat health problems such as seizures and diabetes —  are becoming increasingly scarce.

"If there are prolonged shortages, it does create quite a workflow issue where sometimes patient safety can be compromised," said Mark Percy clinical lead pharmacist with Mint Health and Drugs in Calgary.

Percy says in some cases, there are safe, reliable alternatives. But with some medication, such as anti-seizure drugs and antibiotics, tiny differences in the drugs' make-up can make it difficult to change.

"In those cases switches can be harmful to patients."

Numbers unclear

While many health-care workers agree shortages are a problem, tracking Canadian trends is not easy.

The federal government started requiring that drug companies publicly report shortages in March 2017.

According to Health Canada, about 4,400 actual and anticipated shortages have been reported since then. But it is unclear just how common the problem was prior to that because reporting wasn't mandatory.

Dr. Jacalyn Duffin, Queen's University professor emerita, estimates there are between 500 and 700 drugs in short supply in Canada at any given time.

Duffin, who is trained as a hematologist, has been studying the issue since 2010, when one of her cancer patients wanted to quit chemotherapy treatments because she couldn't get the anti-nausea drugs she needed.

"I discovered there were dozens and dozens of other shortages going on in different aspects of medical care. And they were largely unexplained," said Duffin.

Multiple causes

According to Duffin there are a number of reasons for drug shortages, including a declining number of manufacturers and problems importing or accessing raw materials.

Economics can also play a role.

"Since the majority of the shortages are generics — sometimes they are sold at such a low price that its almost impossible for the manufacturer to make a profit and there's zero interest in making a drug if they're not going to make a profit. That's the way the system runs," said Duffin.

According to David Brewerton, single-source suppliers are also a concern.

"When you've got something that's down to one manufacturer, if they're out, everybody's out," he said.

Both Brewertom and Percy worry the problem could soon get worse. 

The pan-Canadian Pharmaceutical Alliance, a body that negotiates drug pricing on behalf of the federal and provincial governments, recently signed a new deal that will see the prices of nearly 70 of the most common generic drugs drop by up to 40 per cent on April 1.

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