The possible consequences of Canadian drug shortages are just beginning to be appreciated.
In recent months, local pharmacies have sent notifications to my office (often several per day) that certain drugs were suddenly on “backorder” for unknown reasons and for an unknown period of time. These included Adalat and Olmetec and their generics. According to Kelly Grindrod, at the University of Waterloo School of Pharmacy, “Of the roughly 7000 prescription drugs available in Canada, more than 1800 are shorted.” (Toronto Star, August 6, 2019)
So why are these drugs now temporarily unavailable? Is it increased global demand, a sudden lack of active ingredients, or vague manufacturing problems? No one can provide an answer.
The Canadian Pharmaceutical Survey conducted from November 14-December 3, 2018 revealed that in the past 3-4 years, according to respondents, drug shortages had greatly increased by 79% and somewhat increased by 16%. One in four adults in Canada has been personally affected in the past three years, or knows someone who has. The situation is worsening. Three drugs used in cancer therapy – vinorelbine, leucovorin, and etoposide – are in short supply as well as several for hypertension, heartburn, and seizures.
We recognize that name brand and generics of the same drug have different efficacies and potential side effects. Switching patients to a substitute similar drug in the same family is even more likely to lead to unpredictable outcomes. Therefore, most physicians, would likely request that a patient return to the office within a month or so in order to ascertain whether the change to the new drug has caused any adverse effects or loss of efficacy. Obviously, these extra visits cost our health system additional dollars.
A possible unforeseen consequence of these shortages is on “snowbirds” and others planning to leave Canada on vacation. Travel insurance forms are complicated. As Dr. John D. Allingham recently wrote, (See article by Jim Garner, Vancouver sun, July 29, 2019) “It is only when clients make claims that they know that they have been covered.” Most companies will disallow a claim if they deem persons to be unstable. This can be when the dose of a medication is changed; it could certainly occur when patients were forced to switch to a “close-cousin” substitute drug.
Our already frail drug supply system now faces an additional threat. Busloads of diabetics are obtaining their insulin in Canada at 10% of the cost in the United States. Already ten states – including Florida (the third most populous state), Vermont, and Colorado — are passing legislation legalizing the importation of Canadian drugs. This has the blessing of President Donald Trump. It would mainly affect name-brand drugs.
Certainly generic drugs may be affected if Dr. Eric Hoskins’ national pharmacare plan is implemented. At present, most generics are more expensive in Canada than in the US. However, if we were to consolidate existing private and public drug plans so as to increase “bulk purchasing” and negotiate Canadian prices downward, there is no guarantee that a sufficient quantity of drugs would remain for Canadians.
Our country of 37 million cannot solve the exorbitant drug price problem of our neighbor of 325 million. Federal Health Minister Ginette Petitpas Taylor should express our strongest reservations about permitting Americans free access to our very limited drug supply. A coalition of 15 groups of hospitals, health professionals, and patients has already conveyed this message.
Legislation may be needed to restrict the amount of Canadian pharmaceuticals being exported. Also, perhaps those purchasing more than a week or so of medications such as insulin should be required to show ID that they are residents of Canada.
This should be an election issue. The next Canadian Prime Minister must also firmly state to President Trump that even a trickle of drugs from this country will be totally cut off if he threatens to re-impose tariffs on Canadian steel, aluminum, or other goods.
Ottawa physician Dr. Charles S. Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine. He is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association.