It’s not entirely unusual for Canadians see warnings emerge over drug shortages in the country.
In March, for example, Bladder Cancer Canada’s medical advisory board said that it is currently facing a shortage of Bacillus Calmette-Guerin. The organization itself was told of the shortage by drug manufacturer Merck Canada in November 2018.
Merck is the only supplier of the medicine in the country.
So what happens when necessary drugs, such as BCG, are in limited supply?
Here’s a look at why drug shortages happen, and what Canadians who need those drugs can do about it.
What’s happening with the BCG shortage?
Bladder Cancer Canada explained in a release that it is working to mitigate the effects of the shortage of BCG, which is a “standard of care for many patients” with that form of cancer.
It has produced guidelines for doctors on how to handle the shortage, telling them to “closely monitor” their supply and put conservation strategies in place. The guidelines also include a list of alternate treatments that can be considered by medical professionals.
Bladder cancer, which is the fifth most common cancer in Canada, is the most expensive to treat.
The organization says it is currently waiting on Health Canada, as the public agency has final discussions with a potential second supplier for the medicine.
In an email to Global News, Health Canada said the expected end of the shortage is December and it is working on finding an alternate supplier.
“Health Canada has received a submission for market approval (New Drug Submission) of a new BCG product,” the statement read.
“Health Canada expects to make a decision on this submission in fall 2019, after the Department has completed a thorough evaluation of the scientific evidence to support the quality, safety and effectiveness of the product.”
Monitoring drug shortages in Canada
The public health agency added that it plays an “active role” in resolving issues related to shortages, alongside interest groups, provincial and territorial governments, health care professionals and manufacturers.
As of March 2017, legislation requires drug manufacturers to report drug shortages, current or anticipated, to the third-party Drug Shortages Canada database — at least six months ahead of time, or within five days of learning about it.
Health Canada must also be notified if a drug is discontinued in Canada.
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Paul Grootendorst, a University of Toronto associate professor who researches economics of the pharmaceutical industry, explained to Global News that shortages typically emerge when generic drugs are priced low.
The low prices often make drugs more popular, while producing them becomes less profitable, he noted.
“It’s less profitable to invest in productive capacity, such as manufacturing capabilities,” Grootendorst said.
He added that there are other things — such as inspections, difficulty accessing ingredients, and international demands for drugs — that can impact production and cause a low drug supply.
A growing problem?
There have been concerns raised recently that drug shortages are a growing problem in Canada.
Last year, a group of Alberta pharmacists warned the government about shortages of common medications, including those to control seizures and diabetes.
David Brewerton, the pharmacy manager at Lukes Pharmacy in Calgary, said companies are now required to report any shortages to Health Canada and that 4,400 drugs had been added to the list of between March 2017 and 2018.
At any time, Brewerton said, there are about 500 to 700 drugs that pharmacists can’t get.
In some cases, pharmacists can find a workaround — such as offering fractional doses — but many other patients are sent back to their doctor for additional lab work and consultations.
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Barry Power, a senior director with the Canadian Pharmacists Association, told Global News that from a “front line perspective,” shortages have become more common.
“Drug shortages and recalls appear to be increasing from a front line perspective,” he said in an email statement. “Over the past year we have seen this issue impact Epipens, Valsartan, Bupropion, travel vaccines, among others.”
On the Drug Shortages Canada database, there are currently 7,545 shortage reports. Twenty-four per cent of those shortages, or 1,818, are current issues. One per cent of the reports, a total of 57, are anticipated shortages. The remainder have either been avoided or resolved.
A November 2018 survey by the pharmacists association shows one in four Canadians has been affected by drug shortages in the past three years.
What can Canadians do?
The same survey found that between 15 to 21 per cent of Canadians have tried various alternate methods of obtaining drugs, including online purchases, taking drugs from family or friends or other “informal” means.
Power said health care professionals can try to find alternative treatments, it will not be the “optimal treatment.”
“The patient is inconvenienced and may experience a disruption of control of their condition with a change to an alternate medication. As drug shortages increase in prevalence, we need to consider that patient health will be compromised,” Power said.
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For Canadians impacted by drug shortages, Grootendorst said it often just comes down to be having to be resourceful.
“You have to be resourceful, you have to either have your clinician or your pharmacist, or you yourself go and phone around and see who might have that extra supply,” he said.
“It’s like a treasure hunt of sorts, isn’t it?”
The Abacus Data survey mentioned in this story was completed by 1,500 Canadian adults between November 9-13, 2018. The margin of error for a comparable probability-based sample of the same size is plus or minus 2.52 per cent, 19 times out of 20.
— With files from Global News/CHQR reporters Alyssa Julie and Tony King