Shortages of some commonly used drugs are spanning the country and aren’t expected to resolve until at least the new year, causing both pharmacists and patients to search for alternative solutions.
The persistent shortage of Lenoltec No. 4, the generic version of Tylenol 4 (also known as T4s), along with Ozempic, a widely-used drug for Type 2 diabetes, has lasted for several months. Some pharmacists are increasingly concerned over the growing challenge of meeting the demand for these essential medications.
“Certainly the shortages being reported by the manufacturers are impacting all of Canada,” said Jody Shkrobot, assistant clinical professor with the University of Alberta at the Faculty of Pharmacy and Pharmaceutical Sciences. Certain areas in Canada might experience more significant shortages, he explained.
“You might see one pharmacy with a little bit of product because they don’t have a lot of patients that are utilizing that medication versus another pharmacy that has run into situations that they can’t supply their patients,” he said.
Lenoltec No. 4 is a narcotic pain reliever that has been in short supply since April 19, 2023, when it was first reported to Canada’s drug shortage database. Teva Canada, the pharmaceutical company that makes this generic drug, said it estimates the shortage will last until Jan. 10, 2024, according to Canada’s drug shortage database.
Global News contacted Teva Canada to inquire about the cause of the supply shortage but did not receive a response by the time of publication.
On Canada’s drug shortage website, the company stated the reason for the shortage was “disruption of the manufacture of the drug.”
The shortage of Novo Nordisk’s diabetes drug, Ozempic (the one-milligram injection pens) started Aug. 21, 2023, and is expected to be resolved by March 21, 2024, according to the drug shortage database. The limited supply of the product is due to a manufacturing shortage of the plastic used to make the injection pens the drug comes in, coupled with surging global demand for the drug, according to the company.
“Once a shortage has been around for a while, it doesn’t take very long before the supply chain has run out because, for the most part, both pharmacies and wholesalers are running kind of on just-in-time inventory type of process. So once a shortage kind of hits it, it impacts things very quickly,” Shkrobot said.
'The list is getting bigger and bigger'
The shortages of the pain reliever and Ozempic were first reported by Global News on Wednesday.
Pharmacists in Edmonton said they are facing a shortage of these medications with one telling Global News it’s the worst she’s seen in her career.
“It’s actually been two or three more months now but because the list is getting bigger and bigger,” said Ghada Haggag, a pharmacy manager at All Care Pharmacy.
“The medication shortage gets more complicated, like outside of the pharmacy hands that we can control. This is why it’s a bigger problem now. This is so much,” she told Global News earlier this week, adding that in her 23 years as a pharmacist, she has never seen a backlog this bad.
Shkrobot said the shortage affects the whole country.
“Issues that we have for the supply of pharmaceuticals is typically not even just a national basis. So Alberta — Edmonton – is not unique in terms of the situations that we’re seeing for certain medications,” he said.
In an email sent to Global News on Wednesday, a spokesperson from Health Canada said drug shortages are reported by their manufacturers in Canada’s mandatory drug shortage and discontinuation reporting website.
“Another action we take is to work with manufacturers to arrange for the importation of drugs from other countries to help fill Canada’s gap in supply. This helps improve access to supply until the Canadian drug is available again,” the spokesperson said.
What are the alternatives?
Lenoltec No. 4, or Tylenol 4, is primarily used as a pain reliever and has a fairly high level of codeine, explained Shkrobot. “It’s for pain that’s going to be a little bit more severe,” he said.
Given that the medication comprises two widely available ingredients, acetaminophen and codeine, he said finding suitable replacements is a relatively manageable task. However, he added, there’s always the potential for someone’s body to absorb things slightly differently when you change their medication.
“So we can’t say that they’re 100 per cent going to be interchangeable, but you can get equivalent dosages of both of those agents,” Shkrobot explained. “It’s not as convenient having to take them, in two tablets versus one tablet.”
Kyro Maseh, a Toronto-based pharmacist, said his pharmacy has not had the generic Tylenol 4 drug for months, but he said the shortage is still “manageable.” He said he is able to come up with alternate solutions for his customers and no one yet has complained about the replacement.
However, Maseh, said the shortage of Ozempic is by far a more serious problem, as there are not many alternatives to this drug.
“It is an extremely effective (drug), it fixes a whole slew of problems for patients, not just diabetes, but for weight loss, blood pressure, their blood sugar is controlled. It doesn’t cause hypoglycemia like insulin does,” he said.
“The drug is on backorder and there are few similar medications that can be changed for it,” adding that the substitutes are not covered by the government, meaning many of his patients have to pay out of pocket.
For example, he said in Ontario the province will help cover the cost of Ozempic for many diabetes patients, but the alternative mediation, like Mounjaro, is not covered.
He said his pharmacy sees a lot of customers who are over the age of 65 and on welfare, meaning many struggle to afford the alternatives.
“The cost can range anywhere from $250 to $550 a month,” Maseh said, “and the only other alternative is to boost up their insulin and that carries its risks.”
When will the shortages resolve?
While Novo Novartis stated the shortage of Ozempic should be resolved by March 2024, Maseh remains skeptical and is not holding his breath.
“It was supposed to be on backorder until November,” he said. “So every once in a while, our pharmacy is allowed to order one or two (injection pens). But to put things into perspective, we could dispense 12 in a day.”
Until the backorder is filled, he said he spends a lot of his time “triaging patients” in order to treat people who have more severe diabetes.
Allison Bodnar, CEO of the Pharmacy Association of Nova Scotia, said drug shortages like the ones seen with Ozempic and generic Tylenol 4, are unfortunately a new reality in Canada.
“There doesn’t seem to be much of a break these days for pharmacists,” she said, noting that the shortages stem from diverse reasons, including insufficient supply, a shortage of raw materials, manufacturing issues, or heightened demand.
A spokesperson from the Canadian Pharmacists Association echoed this sentiment.
“Unfortunately, drug shortages are a regular occurrence across the country and daily things pharmacists have to manage,” Tyler Gogo told Global News in an email Thursday.
Although substitutes for these drugs are available, there are situations where even supplements experience shortages. Bodnar describes this phenomenon as the “cascading shortage,” which is when pharmacists rapidly exhaust alternative options as well.
While patients await the return of their prescribed drugs to the market, such as the generic version of Tylenol 4 or Ozempic, she said it’s crucial for them to talk with their pharmacists and physicians if they have concerns about the drug supply.
“I think the other pieces are not to hoard,” she added. “Not to take more than you need. Generally speaking, supplies come back into play.”
— with files from Global News’ Jasmine King and Katherine Ward
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