Story 43 Repeated & baffling shortages of specific painkiller

A 70 year-old reader from Toronto area writes:

I have been disabled by spinal cord injury and Multiple Sclerosis pain since 2006 and have Multiple Chemical Sensitivity.  I retired early because of this pain from the national office of a large health charity where I worked for over 25 years in senior positions in education and research. I also participated in consultations and collaborations with the federal government and other health charities and health professional organizations.

For years, I’ve been a patient at St Michael’s Hospital’s Pain and MS Clinics in Toronto under whose direction I’ve tried all available other pain control options.  They either don’t work for me, I have allergic reactions, or the side effects outweigh the value. The only pain medication I can tolerate for my severe MS and spinal cord injury pain contains nabilone and I take a high dose.  Luckily for me, it is non-addictive and unlike many medications, appears to have no dangerous side effects. Frankly, if I don’t have this medication, the pain will be unbearable.

However, it’s been in short supply since June 2017.  I assumed at first this was a glitch in the system but then realized the system is the glitch.

In June, 2017, my local independent pharmacist told me he could not fill my prescription because his supplier was out-of-stock but he knew Shopper’s Drug Mart had a supply. So I take my new 3 month prescription from St Mike’s Pain Clinic to Shopper’s.  My drug plan only permits one month supply at a time but for two months, Shopper supplies.  Then, when I need the third month in August, consternation from Shopper’s – their distributor cannot supply either the brand name or generic form of the drug until January, 2018.  However, that same local independent drug store I normally use now can get a quantity of the drug from its supplier so I had to get a brand new prescription from St. Mike’s.  The local drug store was able to provide the medication for three months, but then their distributor ran out of stock.  Meanwhile, through family members (not health professionals), I’d learned of another drug store that had a supply and St Mike’s sent a prescription there – however, they were now out-of-stock so they could only give me less than 2 weeks of supply.  I didn’t have enough to last until January so I reduced my daily dose to make them last longer but reverted back to my usual dose when I realized my savings only last a few days and meanwhile the pain increase was significant and my stress was affecting my family.

A new just-opened pharmacy we found had some inventory and was able to get me more when the Ontario government released a limited inventory of a small dose previously delisted.

The message from all of the drugstore staff I spoke to from June to December 2017 was that their suppliers said that the shortage would last until January, 2018 and their only advice was to call every drug store in Toronto to see if they have any stock left.  Unfortunately, most of the stores I found who had any at all were holding back supplies for their regular patients.

All of these pharmacists had no idea why the specific drug was in short supply but eventually I learned that there was a worldwide shortage of the active ingredient. By the end of December, 2017, various manufacturers had received approval from Health Canada for a substitute source (email communications) but one respondent honestly commented that no one could guarantee future shortages would not occur.