Adult cold and flu medicines are in short supply across the country as drug manufacturers struggle to keep up with abnormally high demand.
In an email to CTVNews.ca, Health Canada spokesperson Natalie Mohamed confirmed on Friday that while drug manufacturers are not required to report shortages of, or supply issues related to, over the counter medications, the federal health agency is aware of the issue.
"Health Canada is aware of elevated demand and supply constraints of over-the-counter adult analgesics – ibuprofen, acetaminophen and combination products – to treat fever and pain associated with cold and flu, and is working with provinces and territories, manufacturers, distributors, health-care professionals to address it," Mohamed said.
The Canadian Pharmacists Association conducted a rapid poll of pharmacists in December and shared the results with CTVNews.ca. The poll found approximately 25 per cent of pharmacies had no supply of adult cold and flu medicines and 62 per cent had minimal supply.
"So it is definitely something that we're seeing across the country," Joelle Walker, vice president of public and professional affairs at the Canadian Pharmacists Association, told CTVNews.ca on Thursday. "Having gone to many pharmacies, I know that cough suppressants have been off the shelves for quite some time, too."
Walker explained that while some drug shortages are driven by decreased supply – due to the shutdown of a manufacturing facility, for example – this one is being driven by increased demand.
"What we know is that supply continues to come in, much like it does for kids' analgesics," she said. "There was always supply coming in; it was just that it would go off the shelves really quickly, as demand continued to be really high."
Across Canada, Walker said, that demand has been driven largely by the resurgence of non-COVID-19 infections such as RSV, colds and influenza.
While those illnesses circulated at low levels during the first few years of the pandemic – as a secondary consequence of mask mandates and physical distancing – the easing of public health measures in 2022 opened the door for them to return.
"Demand certainly has been higher than last year when there was relatively little circulating because of all of the mask mandates," she said.
Jen Belcher has noticed the same trend in Ontario, where she said the cold and flu season began early this year. Belcher is a community and hospital pharmacist and vice-president of strategic initiatives at the Ontario Pharmacists Association.
"Normally, we see the demand for cold and flu products start to pick up in the fall, it really picks up into the winter, and then will taper off again," she said. "But (this year,) we had high demand at non-seasonal times, so throughout the summer."
She said manufacturers and wholesalers have struggled to keep up with the sustained high level of demand for cold and flu medicines without a break in the summer to replenish their supplies. Additionally, Belcher said a lot of the cough and cold medicine that went unsold during the first few years of the pandemic had to be destroyed, so it's not on the market either.
"We actually had to destroy a lot of expired products because no one was buying colds and flu medications since they were well," she said. "So not only did we end up seeing a surge in demand throughout 2022 and into 2023 now, but our existing stock became aged and dated and needed to be turned over."
Walker added that the rise of RSV infections and the shortage of children's pain relievers across the country last fall may also have contributed to the current shortage of adult cold and flu medications as parents desperate to treat their sick children turned to adult formulations.
"There were ways to split some of the adult pills into a children's formulation, so we saw a little bit of a supply issue there," she said.
Unlike many prescription drugs, over-the-counter cold and flu medications are designed to treat the symptoms, rather than the severity or length, of viral infections.
"They help you feel more comfortable," Belcher said. "But they're not going to shorten the amount of time that the virus takes to improve."
Because these medications are usually made from combinations of pain relievers and cough suppressants, Belcher said anyone struggling to find a cold or flu formula can look for medical ingredients such as acetaminophen, ibuprofen, antihistamines or decongestants in other products with help from a pharmacist or health care provider.
Non-pharmaceutical options like humidifiers can also relieve symptoms such as sore throat, cough and nasal irritation, she said.
"For anyone who's suffering right now, think about what symptoms are the most bothersome for you," Belcher said, "and then your pharmacy team, primary care provider or a nurse can help provide you with some alternatives that might still manage your symptoms."
As part of a long-term solution to pharmaceutical supply-and-demand gaps, Belcher said the federal government should take steps to boost Canada's pharmaceutical manufacturing capacity so it can respond more quickly in situations like this.
"Domestic manufacturing is very linked to government policy, as is the import of products," she said. "So Health Canada would manage the potential imports of drug products and then domestic manufacturing capacity is linked to policy, and whether it comes with any sort of incentives or restrictions"
For now, Health Canada said it is working to address the current shortages of both children's and adult pain relievers by expanding importation of the products from international suppliers.
"Since the summer of 2022, Health Canada, alongside its partners across the supply chain and healthcare system, has been doing everything it can to help alleviate this shortage, including approving the importation of foreign-authorized product to supplement record-level increases in production by domestic manufacturers," Mohamed said in an email to CTVNews.ca on Friday.
"While the focus has been on addressing the shortage of children’s analgesics, Health Canada is also working to address the supply of adult analgesics."
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