Drug shortages worsening as Health Canada starts study to address it

The president of the Canadian Medical Association says the problem of drug shortages is becoming more and more common.

Dr. Louis Hugo Francescutti says doctors are raising the problem with him every time he travels across the country as president of the CMA. And they all want to know why the problem is getting worse.

Francescutti also works in the emergency room of a downtown Edmonton hospital, where he's seen the problem when treating patients.

He recalls his surprise during a conversation about the problem earlier this month when he wanted to give liquid penicillin to a patient.

"The other doc chuckled and I said, 'What?' She said, 'We've been out of that for a couple of weeks now.' And I said, 'pencillin?' And she said, 'Absolutely,'" Francescutti recalled.

'Give us the real reason why you can't produce and supply, on a regular basis, medication you're promoting we should be using in the first place.- Dr. Louis Hugo Francescutti, Canadian Medical Association president

He says it used to be rare for a drug to be unavailable and that it was often a specialized medication. But he says family doctors are now dealing with the problem every day in their practices.

"Is it having impact on regular docs? I would have to say absolutely. And that's not talking about chemotherapeutic drugs or analgesic drugs or anti-hypertensive drugs, or any of the kind of specialized drugs. Penicillin was invented in the 40s last time I checked, so I don't think it should be that difficult to produce," Francescutti said.

Tough questions for drugmakers

There are often alternative drugs, but it takes time to research unfamiliar medications and understand their interactions and side effects, Francescutti added.

"I think the tough questions are to the people who are making these drugs, like really give us the real reason why you can't produce and supply, on a regular basis, medication you're promoting we should be using in the first place."

This particular government I don't think is really interested in trying to tackle this issue by directly confronting the drug companies and do anything significant about it.- York University professor Dr. Joel Lexchin

Health Canada is holding consultations on the drug shortages over the next six weeks. The department is also reviewing the drug shortages website created two years ago by the government and the pharmaceutical industry.

Right now some drug companies voluntarily post when a drug is not available — but not all.

York University professor Dr. Joel Lexchin specializes in health policy and the pharmaceutical industry. He has a number of solutions he says would solve the drug shortages problem, starting with mandatory reporting of a problem, and six months warning when a company plans to discontinue production of a drug. It's currently just 30 days.

Lexchin made these suggestions at a parliamentary committee in 2012, but he says the problem has gotten worse. And he points the finger at the federal government.

"This particular government I don't think is really interested in trying to tackle this issue by directly confronting the drug companies and do anything significant about it," Lexchin said.

When pressed recently during a parliamentary committee, Health Minister Rona Ambrose told MPs she's open to changes.

"I have said many times if it's not working then we will make it mandatory," Ambrose said.

Complex problem

In a statement, a spokesperson for the Canadian Generic Pharmaceutical Association says mandatory reporting may not lead to a solution.

"It is unclear what more this would achieve beyond the current efforts of Health Canada and brand-name and generic manufacturers," Jeff Connell wrote in an email.

The senior director of scientific and regulatory affairs with Canada's Research-Based Pharmaceutical Companies agrees.

"Mandatory reporting doesn't necessarily get you to a place where shortages don't occur," Keith McIntosh said in an interview.

He points out the problem is complex and affects many countries around the world, not just Canada. Both industry associations are part of a working group looking at the issue.