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There is a growing online industry that is diverting Canadian prescription medicines to U.S. residents looking for cheaper drugs by mail.

Until now, regulators of Canada’s health care system have paid little mind.

But the explosion of popularity of Ozempic, a medication for Type 2 diabetes widely touted on social media as a weight loss solution, has exposed an unhealthy practice that requires a remedy from Ottawa, the provinces and medical regulatory bodies.

British Columbia’s Minister of Health, Adrian Dix, asked for an internal investigation after seeing an unusual number of prescriptions for the drug being sent from his province to U.S. addresses. Other countries have experienced shortages of Ozempic, and the trend he uncovered exposes a risk to supply of the drug for Canadians with diabetes.

The preliminary findings, released in March, showed a small number of players involved in a scheme that has the potential to harm Canadians. Stronger rules are needed to ensure that drug supplies in Canada are not jeopardized.

In January and February, almost 16,000 prescriptions for Ozempic were filled in B.C. for patients in the United States. Most of them were processed by two Metro Vancouver pharmacies. And almost all those prescriptions, according to the B.C. government, were signed by a small number of physicians in Nova Scotia.

Doctors in Nova Scotia, according to their standards of conduct set by the province’s college of physicians, must only prescribe medications within a patient-doctor relationship. That means the doctor examines the patient, diagnoses their condition, reviews their existing medications and discusses the risks and benefits of prescriptions. Physicians should exercise caution when prescribing medications to patients whom they have not personally examined, the college warns.

The head of the college, Dr. Gus Grant, describes the number of prescriptions involved in this case as staggering. On Thursday, the Nova Scotia college told The Globe it had taken initial action. One doctor’s licence to practice has been suspended, pending a full investigation.

Legally, Canadian doctors catering to online pharmacy sales abroad are on thin ice.

The Canadian Medical Protective Association provides physicians with legal assistance related to medicine, and compensates patients harmed by negligent care. The association doesn’t explicitly say doctors should not provide non-urgent care to people who are not Canadian residents, but it warns its members not to count on help if they get into trouble when providing such services.

Pharmacists have rules to follow too. The standards of practice for B.C. pharmacists require members to check prescriptions for appropriateness, to review the patient’s personal health information, and to consult with the patient concerning their drug history and other health information. B.C.’s college of pharmacists is reviewing whether those rules were followed. But the volume of prescriptions involved indicates that diligence was likely not exercised.

The issue of cross-border sales of Canadian drugs to Americans seeking lower prices is not new, and agencies such as the Canadian Health Policy Institute have warned for years that Canada needs effective regulation to avoid critical drug shortages.

Health Canada is supposed to take a leadership role in addressing drug shortages. To that end, it prohibits the bulk distribution outside of Canada of drugs that are intended for the Canadian market, if that sale could cause or worsen a shortage. That rule applies to manufacturers and distributors – but not to pharmacies.

B.C. is drafting a regulation, expected to take effect later this month, to curb sales of drugs to U.S. residents when drugs like Ozempic are in short supply. But the trade may simply shift to another province if B.C. alone takes action.

Federal Health Minister Jean-Yves Duclos has expressed support for B.C.’s response, but has not taken any action of his own. While there is no current shortage of Ozempic in Canada, that could easily change. Canada does not have the supply to meet both the medical needs of Canadians, and the weight-loss wishes of Americans.

Mr. Duclos needs to act; he should be co-ordinating a national response to protect Canada’s drug supply – including immediately closing any legal loopholes.

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