Canada is facing a severe drug shortage because of a production slow-down at the leading supplier of most generic, injectable drugs used in Canadian hospitals.
Canadians who need the painkillers, sedatives, and cardiac drugs that are running out are at risk of inadequate care because of an astonishing lack of planning on the part of our country’s leaders.
The Quebec drug manufacturer Sandoz Canada is at the centre of a crisis involving dwindling drug supplies. The emergency has led to surgery cancellations and talk about how exactly the situation became so dire. Sandoz slowed production in February because of a demand by the U.S. Food and Drug Administration to improve its quality-control measures. A fire at the plant in early March then halted production briefly, setting supplies back even further.
The case is a telling example of how failing to oversee corporations has an immense human cost. Drug manufacturers are not in the business of protecting people’s well-being – governments are.
The shortage has especially affected care of the elderly who suffer from chronic illnesses, which often require the pain medication that is in short supply.
Bruyère Continuing Care, which also has a unit to care for the dying, has been switching patients from low-supply drugs to medications to conserve its remaining supply. It has also reduced the quantity of medication patients receive.
The vice-president of medical affairs, Frank Knoefel, says each patient at Bruyère takes on average 10 to 15 medications.
Switching can have side effects, and changing medications from the affected injectable drugs to pills is complicated.
“They’re very complex, very frail people so often they can’t swallow. Especially in the last few days of life – you can imagine in palliative care for instance – your body is slowly shutting down, so swallowing is really not an option.”
Even with the reductions, supplies are teetering on the brink of too low.
“If they stopped delivering altogether, in two to three weeks we’d have a serious problem on our hands,” Knoefel says.
He called this a case study of capitalism gone wrong.
“You have a sole-source, which goes bad, and then you have a bureaucracy that cannot react quickly to this drug shortage.”
Health Canada is reviewing applications for alternative suppliers but the process is fraught with red tape. Most of the applications under review come from foreign manufacturing plants that belong to Sandoz.
Bureaucracy takes time and that’s one thing patients like those in Bruyère’s palliative care unit don’t have. Most patients only have weeks left to live.
It shouldn’t take a crisis before we wake up and realize that pure, unregulated capitalism is not an appropriate system when public health is at stake.
The Canadian Cancer Society has called the shortage completely unacceptable.
“Facts have been difficult to find, and patients, medical professionals and pharmacists have not been given clear information. Full disclosure from the beginning was very much missing,” Lauren Dobson-Hughes, the associate director of public issues, wrote in an email.
The society is calling for the federal government to create an early warning system for potential drug shortages.A severe shortage of the anti-convulsion drug phenobarbital has already forced a hospice in Oakville, Ont., to turn away a dying patient who needed the medication.
The Hospice at May Court, which cares for a maximum of nine patients at a time, hasn’t felt much of an impact from the shortage yet. But even there, executive director David Hogberg, says the hospice probably doesn’t have enough supply of phenobarbital to accept a patient who needs that drug. Hogberg says such a patient would have to be referred somewhere else.
Institutions are at risk of playing a dangerous game of pass-the-patient. The strain on those people and the system is a deplorable example of poor management.
While it may be tempting to blame Sandoz for the shortage, it’s government regulation that is lacking in this industry.
Barring a major organizational improvement, the shortage will get worse before it improves.
The federal government needs to step in and regulate this industry to prevent monopolies over the production of certain drugs.
“The impact is just too great,” Hogberg says. “There have to be some government controls if there is going to be just one company that makes the drugs. And it’s irresponsible.”
If anyone had looked closely at where most of the country’s drugs were coming from and considered the potential worst-case scenario in the event of a production slowdown, we wouldn’t be here now.
“Was it forseeable? Of course it was,” says Hogberg.
Hogberg is optimistic policy makers will find a solution soon. But the federal government did not give anyone evidence to place confidence in its leadership as it babbled away precious time blaming provincial leaders for their critical lack of foresight.
Knoefel says this is also a lesson for health-care providers. He says they should look beyond their own backyards and organize together as a community with a shared interest in doing what’s best for their patients.
If a doctor caring for patients at home runs out of medication, that patient must transfer to the hospital for more.
A lack of resources unevenly distributed between institutions means when one place runs out, it transfers the somewhere else, constantly chasing after the drugs. This increases the burden on the system.
“That’s not the way to care for people that are ill,” Knoefel says.
And that’s what’s most disappointing – these patients deserve better.