The creeping problem of drug shortages

June 28, 2018 by Jacalyn M Duffin, The Conversation
Research shows that the number of drug shortages in Canada are increasing, even though patients may not be aware of it. Credit: Shutterstock

Dozens of drugs are suddenly unavailable every year. In Canada, we read about shortages of Epipens, opioids and antibiotics and before that, it was saline. In India, it is anti-HIV drugs for children. The problem is global, but most Canadians notice only when their pharmacists cannot fill their prescriptions.

Hyped reporting of individual shortages obscures the fact that they are all connected —as symptoms of a bigger, unprecedented and poorly understood problem.

Health Canada has acknowledged the problem, but it has never measured the shortages through time or attempted to analyze the types of products affected —injection or oral, generic or innovator.

Drug shortages provoke great anxiety. For pharmacists and health-care providers, they demand time-consuming and often frustrating searches for alternatives. For patients, they result in the stress and harm of delayed treatments and surgeries. For governments, they increase health-care spending to acquire the scarce products or their replacements from other sources or innovator substitutes.

Some studies have shown that drug shortages can lead to illness and even premature death.

How big is the problem?

To measure the problem in Canada, I, together with Dr. Brian White-Guay of the Université de Montréal and two students, examined publicly available data to assess the size of drug shortages in Canada between 2010 and 2017. Our sources were the websites recommended by the federal government since 2012 (notification of shortages became mandatory only in 2016).

We discovered that the reporting was often incomplete, inconsistent and inaccurate. However, this was the only publicly available information on the problem and it was sufficient to provide a baseline minimum.

Approximately 1,000 shortages have occurred annually in Canada, affecting 1,250 different products during a recent three-year period. Indeed, the number of shortages appears to be increasing, although the apparent rise might be explained by growing pressure to adhere to the policy of mandatory notification —a policy that is not enforced.

The majority (77 per cent) of shortages involve generic drugs, although a significant proportion (23 per cent) also affect innovator drugs.

Without blaming any particular branch of industry, these figures correspond to the relative prescription volume of generic and innovator drugs in Canada.

In addition, we calculate that roughly 10 per cent of all products actively available have been affected by the shortages.

Since Canada does not maintain an Essential Medicines List, it is difficult to know how many of the affected drugs are medically necessary.

Raising awareness

Yet many people who have been affected are unaware of the shortages. If the family doctor substitutes a new drug for an old reliable product, patients might wrongly believe that "newer and more expensive" could mean "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. If they are seniors or on welfare or in the hospital, the drugs are covered through other channels, and it is the taxpayer who will pay the additional cost. If they fall ill because they cannot locate or afford the substitute drugs, they will end up in hospital, and again, it is the taxpayer who pays.

The precise causes of in Canada and all other affected countries are unknown. 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.

The first step in trying to uncover the cause is to measure and characterize the shortages. Our research shows that those in Canada differ from those measured in the United States and elsewhere.

A stable supply of a diversity of medicines will keep health-care costs down, avoid the expense and stress of sudden emergencies and maintain access to medications for the entire population.

Canadians should urge the government to undertake regular analysis of the drug shortage problem. Measurement will generate insight into the extent of the problem and its possible causes, and it will provide a baseline for assessing the effectiveness of policies created to manage and prevent it.

Only when the causes are identified can solutions be found.

Explore further: AMA: docs declare drug shortages public health emergency

Related Stories

AMA: docs declare drug shortages public health emergency

June 26, 2018
(HealthDay)—At the annual meeting of the American Medical Association (AMA), physicians adopted policy declaring drug shortages an urgent public health crisis.

Drug shortages pose a public health crisis in the US

June 18, 2018
On June 12, the American Medical Association announced that drug shortages pose an urgent public health crisis. This crisis should be of concern to all Americans.

Canada needs essential medicines list to ensure supply

June 13, 2016
Canada needs to create a list of essential medicines to help protect against drug shortages, argues an analysis in CMAJ (Canadian Medical Association Journal)

Canada needs national approach to protect against drug shortages

August 20, 2012
Canada needs a national approach to managing its supply of pharmaceutical drugs, starting with a mandatory reporting system for drug shortages, argues an editorial in CMAJ (Canadian Medical Association Journal) and CPJ (Canadian ...

ASHP: SVP, injectable opioid shortages threaten patient care

May 31, 2018
(HealthDay)—The widespread shortages of injectable opioids and small-volume parenteral (SVP) solutions are jeopardizing patient care and placing a strain on hospital operations, according to a report published by the American ...

FDA launches first app to identify drug shortages

March 6, 2015
(HealthDay)—A mobile phone application (app) has been released to identify current drug shortages, resolved shortages, or discontinuations of drug products, according to a press release published by the U.S. Food and Drug ...

Recommended for you

Drug overdose epidemic has been growing exponentially for decades

September 20, 2018
Death rates from drug overdoses in the U.S. have been on an exponential growth curve that began at least 15 years before the mid-1990s surge in opioid prescribing, suggesting that overdose death rates may continue along this ...

Anti-cancer drugs may hold key to overcoming antimalarial drug resistance

September 20, 2018
Scientists have found a way to boost the efficacy of the world's most powerful antimalarial drug with the help of chemotherapy medicines, according to new research published in the journal Nature Communications.

Probiotic use may reduce antibiotic prescriptions, researchers say

September 14, 2018
Use of probiotics is linked to reduced need for antibiotic treatment in infants and children, according to a review of studies that probed the benefits of probiotics, say researchers in the U.S., England and the Netherlands.

Recalled blood pressure drugs not linked to increased short term cancer risk

September 12, 2018
Products containing the withdrawn blood pressure drug valsartan are not associated with a markedly increased short term risk of cancer, finds an expedited analysis published by The BMJ today.

Sugar pills relieve pain for chronic pain patients

September 12, 2018
Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology. And the pills will reduce their pain as effectively as any powerful drug on the market, according to ...

A new approach for finding Alzheimer's treatments

September 11, 2018
Considering what little progress has been made finding drugs to treat Alzheimer's disease, Maikel Rheinstädter decided to come at the problem from a totally different angle—perhaps the solution lay not with the peptide ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.