Canada’s pharmacists worry a lack of data about prescription management could see a repeat of the situation with diabetes and weight-loss drug Ozempic, in which thousands of doses have been mailed over the border to Americans.
Canadian Pharmacists Association vice-president of public affairs Joelle Walker said Americans buying cheaper Canadian drugs is nothing new.
But she said the case of Dr. David Davison, a Nova-Scotia-licensed physician based in Texas who is said by regulators to have prescribed large quantities of Ozempic to U.S.-based customers via BC pharmacies, highlights the urgent need for a “national conversation” on how Canada can protect its prescription drug supply against such mass orders.
The College of Physicians and Surgeons of Nova Scotia said last week it issued an interim suspension of Davison’s licence after learning of his alleged practices from the B.C. College of Pharmacists.
One of the main challenges, Walker said, is that there isn’t a strong sense of the prevalence of mass U.S. buying of Canadian prescription drugs because the data isn’t available.
She said the first step should be securing data on prescription-drug management in Canada, allowing regulators to see where the issues are before being able to address them.
“It’s very easy when you have a very specific case like Ozempic,” Walker said. But without knowing ‘how many other drugs are being sold and in what quantities?’ in an online fashion to Americans, it’s very difficult to come up with the right policy solutions.”
Ozempic’s primary use is to treat diabetes, but demand for the drug has spiked recently due to its so-called “off-label'”use for weight loss, hyped by social media and celebrity endorsement.
Ozempic is a brand-name diabetes medication manufactured by Novo Nordisk, but the medical ingredient in it is called semaglutide. Semaglutide works by mimicking a hormone called glucagon-like peptide-1 (GLP-1), which stimulates the release of insulin and helps to reduce blood sugar spikes.
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But that’s not all that semaglutide has been shown to do; it’s also effective at regulating diet by targeting areas of the brain that make a person feel more full.
Novo Nordisk actually manufactures two drugs where semaglutide is the only medical ingredient: Ozempic for type 2 diabetes, and Wegovy for obesity.
Both drugs have been approved for use in Canada, Ozempic since 2018 and Wegovy since 2021, however the weight loss version is not available yet in Canada.
Both Wegovy and Ozempic are administered through weekly injections. The only apparent difference between the two is that Wegovy can be injected at a slightly higher dosage.
Another very similar drug — liraglutide — works almost identical to Ozempic and Wegovy but but involved daily injections. For diabetes it is sold under the name Victoza but for weight loss, it is labeled as Saxenda and the injection pen puts out a larger dose. Saxenda and Victoza are also manufactured by Novo Nordisk.
The Ozempic issue emerged after B.C. officials discovered that up to 15 per cent of the drug’s prescriptions in the province during the first two months of 2023 went to Americans.
B.C. Health Minister Adrian Dix announced that the province would restrict access to Ozempic for non-residents.
Davison, who graduated from Dalhousie University in 1977, did not respond to requests for comment.
He is listed by the Texas Medical Board as a physician at Texas Tech Family Medicine in Odessa, Texas. His records show no complaints, other than noting under “Non-TMB Disciplinary Actions” that his Nova Scotia licence has been suspended.
The Texas Tech University Health Sciences Center — which operates Davison’s place of practice — said the organization “recently became aware” of the “assertion” that he may have prescribed Canadian Ozempic to U.S. patients.
“We are looking into the matter and will address it internally and as appropriate,” the statement said.
Organizations such as the Canadian Pharmacists Association and the Canadian Health Policy Institute have been sounding the alarm about possible loopholes that allow Canadian prescription drugs to end up in the U.S.
Peter Loewen, a University of British Columbia assistant professor and Vancouver General Hospital pharmacotherapeutic specialist, said price differences for drugs across the U.S. border, combined with the free movement of people and goods, mean regulating the flow of prescription drugs is easier said than done.
“Our economies are intimately intertwined,” he said. “And this issue is one that gets caught up in that.
“It’s the regulatory and trade relationship between our countries, and the fact that so many Canadians move between the two countries, as do Americans, (that) make it non-trivial to come up with what may seem like simple solutions.”
Walker said any discussion about how drugs are prescribed also needs to take into account that Canadians also make use of cross-border prescriptions when travelling or moving to another province.
As such, any new policy on prescription drug movements needs to be “careful” to avoid putting up “unnecessary barriers for Canadians to access care.”
But the status quo, she said, may create panic buying from Canadian consumers if they are not certain their drug supplies are protected.
“We need to make sure that Canada isn’t seen as sort of the solution to an American problem that needs an American solution.”
— With files from Kathryn Mannie and Karen Bartko, Global News
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