After 'nightmare' of pain, woman with MS questions why drug shortages aren't prevented

It's like you're "burning from the inside out."

That's how Melanie Gaunt, a 46-year-old Nova Scotian with multiple sclerosis, describes the pain when she can't get the medication she needs — and that's happening quite often these days.

Gaunt had been taking a generic drug called nabilone for the past decade as a way to control the pain caused by the autoimmune disease attacking her brain and spinal cord. She considered the synthetic cannabinoid "a godsend."

So it came as a shock this fall when back-to-back manufacturer shortages forced her to significantly cut the number of pills she took each day. The second shortage struck just before Christmas.

"I was horrible. I was in pain the whole time," said Gaunt, who lives at a nursing home in Bedford, N.S. "You're not very friendly when you're in pain."

The turmoil faced by Gaunt may be an emerging offshoot of the opioid crisis in Canada, according to one pharmacist. As doctors seek alternatives to prescribing addictive opioids, it could lead to unexpected demand for pain medications like nabilone.

The experience also has Gaunt and her mother, Lorely, questioning whether the federal government should be doing more to prevent drug shortages in the first place.

Lorely Gaunt said she was willing to forgive the manufacturer, Teva Canada Ltd., for the first nabilone shortage because "we all make mistakes." But when her daughter called —​ crying —​ to tell her about the second shortage, "all the anger that I had,​ plus more,​ just surfaced so quickly."

A spokesperson for Teva Canada, Stephanie Brooks, said demand for nabilone tripled in the 18 months leading up to December, which the company had not anticipated.

While it has since scaled up production, Brooks said, it is challenging for drug manufacturers to accommodate a sudden shift in the market. She said the latest shortage of nabilone will likely continue until this summer.

Pharmacist Cynthia Leung, who works in primary care in Kingston, Ont., and has blogged about the nabilone shortage, said the opioid crisis might be contributing to the sudden increase in demand for synthetic cannabinoids.

Many physicians are trying to limit how often they prescribe opioids for pain relief, but "sometimes the comfort level is still not there to prescribe medical marijuana," Leung said. Nabilone provides an alternative.

She said generic drug companies aren't doing enough to keep track of how the prescribing habits of doctors are changing.

Politicians can do more to force drug manufacturers to meet demand for generic drugs, she said, and a national strategy to prevent drug shortages would be the place to start.

Lorely Gaunt said she was surprised such a thing didn't already exist.

"I thought that the government ... had our backs," she said, "but they let us down." Generic drug manufacturers, she said, "should be held to account for messing with people's lives."

Health Canada spokesperson Renelle Briand said the federal government works "closely and collaboratively" with the provinces and territories, manufacturers, distributors, doctors and pharmacists to prevent drug shortages wherever possible — although she didn't specify how.

She added that Health Canada launched a website last year — drugshortagescanada.ca — that aims to keep Canadians in the loop when shortages occur "so that they have sufficient time to adapt."

Melanie Gaunt said she decided she couldn't trust Teva Canada to supply her with the pain medication she needed, so she's weaned herself off nabilone completely and made the switch to cannabis oil.

She said the fact there is no system in place to prevent drug shortages in Canada is "beyond comprehension."

"I don't think it's fair at all. I think it's unacceptable," she said.

The idea that people are falling asleep at night, worrying they might not have access to their pain pills the next day is a "nightmare," she said.