Canada needs national plan to protect drug supply, prevent shortages: editorial

TORONTO – Ottawa needs to take the lead in formulating a national plan to manage Canada’s prescription drug supply and deal with ongoing unpredictable medication shortages, argues an editorial jointly published Monday in two medical journals.

The editorial in the Canadian Medical Association Journal (CMAJ) and the Canadian Pharmacists Journal (CPJ) says the federal government needs to take action to ensure patients across the country get the medications they need.

“It is ridiculous and intolerable that a wealthy, developed nation like Canada cannot reliably provide medicines to its people,” write CMAJ deputy editor Dr. Matthew Stanbrook and Rosemary Killeen, the CPJ’s editor-in-chief.

As with most countries worldwide, Canada has been experiencing shortages of many critical medications, among them chemotherapy drugs, antibiotics, anesthetics and pain killers.

The drug shortage was compounded early this year when Sandoz Canada, which provides 80 per cent of generic injectable medications used by hospitals, cut production at its Boucherville, Que., plant to upgrade the facility due to quality-control issues. A subsequent fire at the plant further eroded its ability to supply its full range of products.

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“What’s changed about this issue is the scope and extent of shortages,” Stanbrook, a respirologist at Toronto’s University Health Network, said in an interview Monday.

“We’ve always had occasional shortages in the past. But in the past two years there’s been nothing like the number of drugs affected at any one time, and the fact that they’re continuing to occur,” he said. “These trends are going to continue and that’s the reason why we need to start taking it more seriously.”

In their editorial, Stanbrook and Killeen argue that Ottawa should make it mandatory for pharmaceutical companies to report impending drug shortages instead of relying on voluntary systems now in place.

Stanbrook said that after U.S. President Barack Obama issued an executive order last fall requiring mandatory advance reporting of manufacturing stoppages that could lead to shortages, the number of drugs in short supply was cut in half.

“That’s the kind of action that we’d like to see in Canada,” he said.

Federal Health Minister Leona Aglukkaq was not available to comment Monday, but a spokesperson for her office said by email: “We are pleased with the progress on voluntary reporting and will continue to monitor the situation.”

The authors of the editorial say other concrete steps could be taken to ensure doctors and pharmacists aren’t left scrambling for the appropriate drugs to treat patients, among them:

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– Expanding the federal pharmaceutical stockpile to include more drugs that are deemed essential to health care

– Establishing contingency plans whereby provinces and territories could share supplies across the country and restock from alternate international suppliers quickly if a shortage occurs

– Requiring that supply contracts for all essential drugs be made with a minimum of two suppliers

Stanbrook said pharmaceutical companies could also be offered incentives to manufacture drugs in short supply, many of them generic versions that are less profitable than patented brand-name products.

Contracts could also include built-in penalties that would come into play if a manufacturer fails to meet its supply targets, he said.

“The provinces and territories need someone to follow, to take the lead here and co-ordinate Canada’s response to this.”

However, Aglukkaq’s office said that while Health Canada continues to work with the pharmaceutical industry, health providers, and the provinces and territories to solve the drug-shortage problem, its primary role is to approve safe and effective medications for the Canadian market.

“The shortage that took place in early 2012 (related to the Sandoz plant) highlighted the risks associated with sole-source contracts,” the spokesperson said.

“It is up to the provinces and territories to negotiate their contracts with the supplier and manage their supply of drugs.”

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