The government signalled its support for a national drug strategy as hospital officials across the country grappled with the question of how low to let their reserves drop before deciding to cancel elective surgeries.
MPs voted unanimously on Wednesday in favour of an opposition motion calling on the government to work with the provinces, territories and industry to develop a nationwide strategy to anticipate, identify and manage shortages of essential medications. Drug manufacturers would also be required to report promptly to Health Canada any planned disruption or discontinuation in production.
The motion does not commit the government to pass legislation to create a drug strategy, but is a sign of its willingness to move in that direction. It comes amid ongoing problems at the factory that manufactures about 90 per cent of Canada’s generic injectable drugs, forcing hospitals to switch patients to different medicines and carefully conserve supplies.
On Tuesday, hospitals in Vancouver cancelled nine elective cardiac surgeries over concerns they were running low on protamine, which reverses the effects of a blood thinner used in heart bypass surgery. Two Gatineau hospitals also suspended elective surgeries for several days last week over supply concerns.
Vancouver Coastal Health later said Tuesday’s cancellations were based on a misunderstanding – and that the hospitals actually had five-week supplies of the drug, well within the normal range. But the suspensions highlight the current challenge of tracking how many drugs are in stock and determining what level of supply should precipitate a reduction in services.
“Basically the conversation [among hospital officials]at the moment is that they’re trying to come up with a protocol to identify when their drug supplies are to a point where they have to start considering cancelling surgery,” said Rick Chisholm, president of the Canadian Anesthesiologists’ Society.
“I think the motion is great and will help moving on to the future, but at the moment, at least based on what I’m seeing, there is the potential for some problems in the near future.”
Speaking in the House of Commons on Wednesday, Prime Minister Stephen Harper said the shortage was created by the lack of planning on the part of some provinces, which relied on a sole supplier for the drugs that are now hard to find. He said the motion to address the shortages, which was tabled by New Democrat MP Libby Davies, “contains exactly the steps that we have been following for some time.” So the Conservatives opted to vote in favour of it.
Ms. Davies told MPs that, if the Prime Minister is correct and the government is already working with the other jurisdictions to address the drug supply, “then why are the provinces, the territories and health professionals all calling for federal action and leadership?”
Drug shortages have been a problem for doctors and their patients since long before the fire at the Sandoz Canada plant in Boucherville, Que., temporarily halted production. The blaze followed a letter sent to Sandoz from the U.S. Food and Drug Administration raising concerns about the level of sanitation at the factory, which affected only drugs exported to the U.S.
A report written one year ago by the Canadian Agency for Drugs and Technologies, an agency funded by the provinces and federal government to provide advice about health matters, said issues with the supplies of medications are not uncommon and are expected to increase in both frequency and duration.
It is difficult to assess the extent of the problem, says the report, because manufacturers are not required to report disruptions in the drug supply to Health Canada and because there is no single accountable Canadian organization that provides system-wide drug distribution oversight. Ms. Davies’s motion, presumably, would go some way to addressing that problem.
But Leona Aglukkaq, the federal Health Minister, said that, since neither the fire at the Sandoz plant nor the letter from the FDA could have been predicted, requiring the company to alert its customers of future shortages would have done little to avert the current situation.
Ms. Aglukkaq is insistent that the drug supply is the responsibility of the provinces and territories, which “know the needs of the Canadians they serve, they know what drugs are consumed and in what quantities, they know what to order when entering into contracts with the pharmaceutical industry.”
John Haggie, president of the Canadian Medical Association, said there is no doubt that a cross-Canada, and perhaps even an international, strategy is required. “It’s not just Canada that’s affected. This is headline news in Australia, it’s making the headlines in various of the U.S. states,” Dr. Haggie said in a telephone interview on Wednesday.
In Canada, he said, “we’ve been running with shortages of a random and unpredictable nature for quite some time now in the community, but this [current shortage]actually hits at the heart of the acute-care sector in a very significant way.”