Nova Scotia’s college of physicians has suspended the licence of a doctor who allegedly signed more than 17,000 prescriptions in the span of three months for a diabetes drug that is widely used off-label for weight loss. The prescriptions, filled in Canada, were mostly sent to U.S. patients.
“Based on volume alone, the prescribing is not in keeping with the standards of the profession. I cannot see how the volume of medications prescribed could possibly be supported by proper medical assessment and judgement. On its face, the prescribing appears incompetent,” Dr. Gus Grant, registrar and chief executive officer of the College of Physicians and Surgeons of Nova Scotia, said in a statement on Thursday. He said a more detailed investigation is now under way.
Dr. Grant’s statement names Dr. David William Davison as the prescribing physician. The Nova Scotia college lists only one physician by that name and the college’s website lists his practice in Monahans, Tex. The statement said Dr. Davison lives in the U.S. but holds a Nova Scotian licence. Dr. Davison could not be reached for comment.
Pharmacists in Canada require the signature of a Canadian doctor to fill prescriptions for U.S. citizens.
B.C. Health Minister Adrian Dix discovered the pipeline of Ozempic from Canada to the U.S. late last year when he directed his staff to provide coverage for the drug under PharmaCare, the province’s publicly funded prescription program. The challenge, he learned, was that a significant amount of the province’s supply was being diverted to the U.S., raising concerns about availability. While the province did approve coverage, Mr. Dix also ordered an internal investigation into the online pharmacy trade of Ozempic.
That probe found that two pharmacies in Metro Vancouver were filling most of the prescriptions signed by a Nova Scotia physician, and delivered to addresses in the United States.
The College of Pharmacists of BC says it has inspected some pharmacies to determine whether they are compliant with its standards of practice related to online sales, and its review continues. The standards require pharmacists to check prescriptions for completeness and appropriateness, to review the patient’s health information, and to consult with the patient concerning their drug history.
Mr. Dix said the case with Ozempic has exposed a troubling gap in Canada’s ability to protect its drug supply. “The process itself raises issues and concerns,” he said in an interview. He said Canada doesn’t have enough supply of Ozempic to serve the American market and still protect patients in Canada. “And it’s not the only circumstance where this risk might exist.”
Online companies are targeting U.S. customers with the promise of “cheap” Canadian Ozempic. Because Canada regulates the price of patented drugs, the cost of Ozempic is three times higher in the United States.
Online pharmacies such as Canada Drugs Direct encourage U.S. shoppers to take advantage of the benefits of a health care system that is not geared for profit.
Cross-border pharmacy shopping has been an issue for years. In 2019, while seeking the Democratic nomination, Bernie Sanders travelled with a busload of Americans up to Windsor, Ont., who were crossing the border for less expensive insulin. But online shopping has made the practice even more accessible.
Later this month, British Columbia is expected to enact a regulation that will allow the province to halt online sales of prescription drugs to U.S. residents when supplies are low. B.C.’s regulation still leaves the door open for online pharmacies to simply move their sales operations to other provinces.
Mr. Dix is calling on Ottawa, and his provincial counterparts, to also deal with the regulatory gaps that exist. “The federal government surely has a role to play,” he said.
Federal Health Minister Jean-Yves Duclos, in a written response from his office, said he supports B.C.’s action, but there is no prevalent shortage of the diabetes drug Ozempic in Canada at this time.
Ozempic, produced by Denmark’s Novo Nordisk, is a class of medication called semaglutide that is approved in Canada for treatment of Type 2 diabetes. Semaglutide can help patients manage blood sugar levels when metformin, another diabetes drug, is not effective.
Ozempic’s dominance of the market has been sparked by Novo Nordisk’s heavy advertising campaign in the U.S., as well as widespread speculation on social media about which celebrities are using the drug for weight loss. That popularity may ebb as other versions of semaglutide become available, including Novo Nordisk’s Wegovy, which has been approved specifically for weight loss.
That means consumer interest may just move to a different label, Mr. Dix said. He plans to press Mr. Duclos when they meet later this month to close the loopholes so that other drugs aren’t similarly exploited.
“Waiting for shortage doesn’t seem to me to be good strategy,” he said.