Drug-shortage problem poorly understood, say experts

by Leo Almazora29 Jun 2018

Shortages in opioids, antibiotics, and Epipens in Canada have been rising in incidence, causing great anxiety for patients, pharmacists, and healthcare administrators alike. Experts say it all points to a bigger, unprecedented problem — one that is not yet well understood. 

“Health Canada has acknowledged the problem, but it has never measured the shortages through time or attempted to analyse the types of products affected,” wrote Jacalyn Duffin, Professor Emerita in the Hannah Chair, History of Medicine at Queen’s University, in The Conversation.

In an effort to measure the problem in Canada, Duffin said she worked with Dr. Brian White-Guay of the Université de Montréal and two students to analyze publicly available data on drug shortages in Canada. They found that the reported data, taken from government-recommended websites, were often incomplete, inconsistent, and inaccurate, but the researchers said they had enough to make baseline determinations.

“Approximately 1,000 shortages have occurred annually in Canada, affecting 1,250 different products during a recent three-year period,” Duffin said. “[T]he number of shortages appears to be increasing, [which] might be explained by growing pressure to adhere to the policy of mandatory notification — a policy that is not enforced.”

She noted that 77% of shortages involved generic drugs, while the remaining 23% involved innovator drugs. The percentages correspond to the relative prescription volume of generic and innovator drugs in Canada, she added.

The researchers calculated that the proportion of actively available products that have been affected by the shortages was 10%. Canada’s lack of an Essential Medicines List, she noted, makes it difficult to determine how many of the affected drugs are medically necessary.

According to Duffin, those affected are typically unaware of the shortages because their doctors typically switch them to a new, more expensive drug — one that patients might automatically assume to be better.

“If they are lucky enough to have a drug plan, the added cost is absorbed by the insurer or later the employer when the premiums rise,” she wrote. Seniors, welfare recipients, and those confined in hospitals receive coverage through other channels, which taxpayers cover. Those who get sick because they can’t afford or find the substitute drugs, she added, would end up hospitalized and create additional costs for taxpayers.

“Little has been done to analyze root causes or explore the consequences of Canada’s limited capacity to supply its own needs for medicines with locally manufactured active ingredients and finished products,” Duffin said. “Canadians should urge the government to undertake regular analysis of the drug shortage problem.”

 

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