Canadians trying to access crucial medication last year might have found their prescriptions were harder to fill thanks to an increase in reported drug shortages that Health Canada says has continued throughout 2023.
While the spike represents an increase in the number of shortages and their length compared to 2020 and 2021, however, it actually brings Canada back in line with a trend that goes at least as far back as 2017, when reporting began, according to data provided by Health Canada to CTVNews.ca.
It's a trend Jen Belcher, pharmacist and president of strategic initiatives for the Ontario Pharmacists Association, knows well.
"Drug shortages overall over the last five to 10 years…have been really much greater in quantity and severity than we've ever seen before," she told CTVNews.ca in a phone interview. "From the children's pain and fever medication last year, cold and flu products, antibiotics, but really, you know, even some critical medications for the cardiovascular events like a nitroglycerin spray."
So far this year, Health Canada has received 2,452 shortage reports, representing 1,673 unique marketed prescription drugs. A drug is considered "in shortage" when its supply does not meet demand. Marketed drugs are those that are sold in Canada – since not all drugs approved in Canada are actually on the market here – and unique shortage reports are what remains after duplicated reports are removed from the total.
"Since the beginning of mandatory reporting legislation, March 2017, an average of 2,556 shortages of marketed prescription drugs has been reported each year, representing an average of 1,840 unique drugs in shortage annually since 2017," the agency wrote in an email to CTVNews.ca.
Between 2017 and 2019, the number of new shortages reported each year remained steady, averaging 230 reports per month. By 2019, however, those shortages were beginning to last longer than they had previously. Then, in 2020 and 2021, something changed.
The average number of new shortages per month dropped to 187, and the duration of those shortages was shorter. Public health experts have theorized that cases of infectious diseases besides COVID-19 dropped during that time, since most Canadians were practising physical distancing and wearing masks in public, both of which helped prevent the spread of common infections.
In 2022, as pandemic-related restrictions loosened, public health units across the country saw a resurgence of certain bacterial and viral infections. At the same time, Health Canada says, the number of reported drug shortages rose to an average of 222 per month, nearly back to pre-pandemic levels.
"Last year saw an uptick in both the duration of shortages as well as the average monthly number of new shortages," the agency told CTVNews.ca. "So far in 2023, the trends for number of reports and shortage duration are similar to last year."
The agency cites manufacturing disruption, increased demand, delays in shipping, a shortage of an active ingredient and a general "other" as the top five drivers of the current shortages.
As for duration, shipping delays are responsible for the longest-lasting shortages in 2023, followed by "other," good manufacturing practices compliance requirements, shortage of an inactive ingredient, increase in demand, disruption of manufacturing and shortage of an active ingredient.
DRUGS IN SHORTAGE
Fortunately for Canadians, Health Canada noted the majority of reported drug shortages don't ultimately result in any impacts at the patient level.
Dr. Barry Power, chief pharmacist officer at the Canadian Pharmacists Association, confirmed this in an interview with CTVNews.ca.
"At any time there's somewhere around 1,500 active shortages. A lot of those never make it to the pharmacy level," Power told CTVNews.ca in a phone interview.
"Manufacturers are required to register shortages and potential shortages with (DrugShortagesCanada.ca). So it could be that the issue is resolved before the inventory that's in the supply chain is exhausted."
When a drug shortage lasts long enough to affect consumers, however, the results can range from disruptive to disastrous.
PATIENTS LEFT CANVASSING PHARMACIES
Lori McConnell, 68, manages her Type 2 diabetes with Ozempic – at least, she's trying to.
She had been on the medication for 13 weeks when, for the first time, her pharmacy team told her in mid-November that they couldn't fill her prescription. Their supply ran out amid a nationwide, months-long shortage of the drug.
"People are being prescribed this, but it's not available and your pharmacy and your doctors are telling you to call pharmacies all over the place to find it," she told CTVNews.ca in a phone interview on Nov. 15.
McConnell switched to Ozempic from her previous prescription, Metformin, in August hoping it would reduce her risk of heart attack or stroke in addition to managing her diabetes.
She struggled with some of the drug's side effects – nausea, vomiting and constipation – for about three months as her body adjusted to the medication. Just as those symptoms were subsiding, she realized just how unstable the drug's supply has become.
Ozempic is administered through a weekly subcutaneous injection, and while some pharmacists have said they're rationing their inventory by dispensing four doses at a time, McConnell has now resorted to canvasing multiple local pharmacies for her next dose on a weekly basis. At one point this month, she was three days late administering the medication.
"Most places, if they do have it, will only give you one pen at a time. It's really hard because I have five refills on my prescription," she said.
"But I'm due for another dose…and I'm having trouble getting another one. And they say it's not going to straighten itself around or become plentiful until January."
McConnell said that if she's forced to stop taking Ozempic and return to her previous prescription, she won't start taking it again once the shortage is resolved. She's not willing to risk enduring the initial side effects of Ozempic a second time.
'GREATEST POTENTIAL IMPACT'
In addition to shortages of medications like Ozempic, there are also 30 Tier 3 shortages as of late November. These are the shortages with the greatest potential impact on Canada's drug supply and health-care system, and right now they include drugs like nitroglycerin for cardiac events, antibiotics, blood thinners and at least one chemotherapy drug.
Other drugs currently on the list include ketamine, calcitonin used to treat osteoporosis, medications to treat severe hypoglycemia, birth control medication Depo-Provera, ophthalmic and anti-inflammatory steroids, and seizure medication vigabatrin.
This line graph supplied to CTVNews.ca by Health Canada shows the number of concurrent Tier 3 drug shortages across Canada by month, starting in March 2020 and ending in May 2023. (Health Canada)Last year saw 34 Tier 3 shortages, according to Health Canada.
What makes Tier 3 shortages so disruptive to patients and health-care systems, Belcher said, is that the drugs are used for "very specific purposes and have very few therapeutic alternatives."
For these reasons, Health Canada said it does "everything it can" to prevent shortages when possible and to mitigate their impacts when they do occur, including working with provincial and territorial governments, industry stakeholders, health-care system partners and patient groups.
"Health Canada has a number of tools available to help address and prevent drug shortages," the agency wrote in an email to CTVNews.ca.
"These include allowing temporary flexibilities in the regulatory requirements to speed up the process of getting drugs to the Canadian market, accelerating approvals for new drugs or changes to existing drugs, and authorizing the importation of foreign-authorized drugs manufactured to similar standards as Canadian-authorized products."
In Part 2 of our series on drug shortages, CTVNews.ca looks at factors driving the shortages, how pharmacies cope with them and potential ways Canada can mitigate them.