Family physician, Dr. George Miller, long in practice in southwestern Ontario and a former President of the Ontario College of Family Physicians, writes in response to our CMAJ article with an excellent question that embodies a suggestion! We agree.
Dr Miller writes:
The CMAJ mentions that this has been a problem since 2010 but it has been present for long before that. Around 2006, the pharmacy in our building started issuing a list of common drugs that could no longer be obtained, and as you have already noted, the list consisted exclusively of cheap, proven medications for which the patent had run out. They were all generic. By the early 200s it was impossible to prescribe as simple an antibiotic as penicillin G or V, despite the fact that it was still effective in simple strep infections and cost pennies. I remember over 14 commonly-used medications being on one list including antiemetics, cheap antibiotics, and some of my epileptic patients had to visit numerous pharmacies to find medication that had kept them stable for years.
Even then we were were being told by the drug companies that the problem was “complex”, but I don’t think it is at all. It all boils down to what is most profitable to produce.
I think the solution is for our government to found a crown corporation to produce the common, proven cheap medications that the drug companies are unwilling or unable to provide. This would be on a non-profit basis. The benefits would be many. If doctors were able to prescribe proven and cheap medication for common conditions rather than blockbuster drugs, the cost to Provincial drug plans would decrease. Also the corporation would be able to export cheap, proven medication to third world countries in desperate need. I well remember a colleague of mine arriving in Africa as part of doctors without borders to find one bottle of tetracycline in the clinic for a population of over 2,000. Although such a crown corporation would make no profit, it would provide jobs for many people and could become an international Canadian industry.
Congratulations on your article in the CMAJ. I hope that you are able to effect change.
George B Miller
Family Physician & LTC (retired)
A psychiatrist in SW Ontario writes:
Yesterday, I had a long conversation with a local pharmacy and they are out of Epival, generic, until Feb 26 at the earliest. They ordered in 125 mg tabs of the parent drug for my patient. Nobody has 250 mg tabs and for many people, they will be unavailable. Epival is one of the drugs used with Bipolar patients and is used extensively in Psychiatry for other problems. I am haunted by the thought of a number of previously stable people becoming ill through this problem.
A woman from British Columbia writes …”I am so scared that I can’t function.” She continues:
Do you realise that drug manufacturers and wholesalers do not contact pharmacies when there’s a drug shortage or outage?
If you personally don’t keep on top of your meds, you could go to get your prescription filled as I did for my anti-anxiety drug, clonazepam, and found out “Sorry Discontinued”!
Shock, anxiety, and fear!!! What do I do now, when the doctor says don’t change brands, and even different brands are out too.
I also need divalproex to treat symptoms associated with severe depression. Without this medication I am back in hospital and going through shock treatments to get on another med. This drug divalproex gave me my life back, without it I have no life.
Another anti-depression med is out until May 2016, you just can’t stop these drugs! So that’s 3 meds in a year I’ve had to deal with.
The first discontinued drug change,,,,, caused me to have flu like symptoms for 6 days, not knowing if that god awful feeling was to abate I lived in fear, but it did stop.
But I can’t be lucky enough to change over that easy with others, I attempted suicide in 1998 because nothing helped, hospitalised and a great doctor put me on the right path!
I don’t need to loose my life over a drug shortage that can be prevented.
Most pills and raw materials come from foreign countries like India, China and Israel, who go through natural disasters, wars and manufacturing issues.
Right now people are running out of their heart, cancer and mental illness drugs – meaning without those medications you become very sick or worse!
Since 2014 over 300 medications have been discontinued, 200 resolved and as of November 5th 2015, there are over 700 drugs out of stock!
Some are estimated to be back in stock as far as August 2016 that are still being made, how do you last that long on a month to month prescription? I just noted on the website, one drug is out until December 2016. Yikes!
Why isn’t the government looking into this, the FDA and CANADA HEALTH REGULATIONS have to pass these out of country meds too, which takes even longer to see if they are up to standard qualities.
One of my meds has been out 10 months and now two are due in, in May 2016, and that’s an estimate only and if I didn’t keep on top of things I’d be very sick and back in hospital, and it still could happen!
So if you want to keep updated on what’s going on go to—www.drugshortages.ca—-and register and keep in touch with your doctor and pharmacist.
THE CANADIAN DRUG SHORTAGE DATA BASE.
I’m lucky to have this knowledge and a great pharmacy that looks after me with a good doctor that orders a stock pile of meds so I try not to run out.
You know who you are and I thank you from the bottom of my heart.
A dentist in eastern Ontario reports that triazolam has not been available for conscious sedation during dental procedures for about six months.
On 26 September, posted this announcement:
The Public Health Agency of Canada (the Agency) has been made aware of a national cefixime shortage which is expected to last until September 2015. There is only one Canadian supplier of cefixime at present; however, the shortage is a result of a problem with a third party manufacturer.
Gonococcal infections have shown progressive resistance to penicillin, tetracycline, and quinolones; third generation oral and injectable cephalosporins are the last remaining first-line treatments. As one of the recommended treatments for gonococcal infections, the shortage of cefixime hinders our efforts to control this infection.
A pharmacist in a cancer treatment centre reports that his hospital’s stock of cancer chemotherapy drug, paclitaxel, produced by the Canadian firm Biolyse, has run out. Soon an order will be placed with the American firm, Hospira.
The Hospira price for a treatment is $4000 — whereas the Biolyse price is $50.
The increased, unexpected, annual cost to his institution will be over $2M.
Health Canada inspectors revoked the licence of Biolyse because of publicly unspecified safety violations, and it had to stop production.
The pharmacist asks the following questions, which we cannot answer:
1. If safety had really been violated, why were pharmacies allowed to use up the remaining stock presumably made under the same “unacceptable” conditions?
2. Why is the American firm’s price for this drug 80 [EIGHTY!] times that of the Canadian company?
3. What are the real costs of manufacturing this drug?
pharmacies. Sometimes it is possible to get a replacement drug that way
depending on what the drug is.