Widespread shortages of common drugs are hitting pharmacies across the country, putting the health of patients at risk and raising questions about the stability of the global pharmaceutical supply.
Nearly 90 per cent of pharmacists across Canada say drug shortages have greatly increased in the past year, forcing them to dispense less-effective medications to patients and spend increasing amounts of time trying to track down suitable replacements.
"The vast majority of pharmacists are facing drug shortages on virtually every shift they work, no matter where they work," said Dennis Darby, CEO of the Ontario Pharmacists' Association. "It's not a good news story for anyone in the system."
The drug supply problems are outlined in a new report published Wednesday by the Canadian Pharmacists Association that calls for increased oversight of the country's drug market to prevent future backlogs.
Antibiotics, anti-nausea and heart medications are among the top drugs Canadian pharmacists say have been in shortest supply in the past several months. They include penicillin, antibiotics tetracycline and cephalexin, amitriptyline (an anti-depressant), and heparin (a blood thinner).
Sandy Buchman, a family physician who practises full-time palliative care and is president-elect of the College of Family Physicians of Canada, said the drug shortages are standing in the way of delivering the best patient care. He was recently unable to prescribe his first drug of choice to treat a palliative care patient's severe nausea because of the shortage and was forced to prescribe a less-effective drug.
"We have to deal with second-best alternatives," Dr. Buchman said. "The impact is huge because you can imagine there are severe symptoms that are only being treated with alternatives, [which are]sometimes inadequate or sometimes even more expensive."
In the new report, the Canadian Pharmacists Association surveyed 427 pharmacists from across Canada. Nearly all reported routinely having problems finding medications to fill prescriptions and 70 per cent said they believed the health of patients was negatively impacted as a result.
Scarce raw ingredients, manufacturing glitches, shrinking production of a particular drug and government rules that lower the prices generic drug companies can charge are among the chief causes of the shortage outlined in the report.
Part of the drug shortage problem is that more manufacturers are getting their raw ingredients from countries such as India and China. That could leave them vulnerable to problems such as ingredient shortages, contamination or problems in those countries' plants.
The drugs in short supply tend to be older generics, which are less expensive than newer, brand-name drugs. That has led some in the medical community to suggest supply problems stem from the fact generic drug companies are reluctant to spend money producing drugs that don't make much money.
The report states that new provincial pricing regimes, which lowered the price of generics in Ontario and other parts of Canada, "acts as a disincentive to production of particular drugs."
But Jeff Connell, director of public affairs at the Canadian Generic Pharmaceutical Association, said new pricing programs have nothing to do with the continuing drug shortages.
"It's not accurate to blame it on the government," Mr. Connell said.
The bigger challenge, he said, is the fact many of older generics tend to be produced by only one or two companies, making the supply of those drugs vulnerable to any problems with the supply of ingredients or glitches at the manufacturing plant.
The problem isn't unique to Canada. The U.S. is in the midst of what some describe as the worst drug shortage in the country's history, with some pharmaceutical companies and industry experts citing problems with raw active ingredients as a major source of the backlog.
Supply problems involving the key ingredients used to make drugs is a serious concern, and suggests that drug shortages could become a familiar occurrence as more countries compete for access to medications in a global marketplace, said Joel Lexchin, a professor in the School of Health Policy and Management at York University in Toronto.
"It makes sense from [the drug company's]point of view, but means they don't really have control over the supply of these things," he said.
For instance, there were major fears of a worldwide heparin shortage in 2008 after tests showed the Chinese-made blood thinner was contaminated, leading to a major recall in several countries, including Canada.