Assessing Canada's Drug Shortage Problem

Abstract

Drug shortages provoke great anxiety among patients who cannot obtain trusted medications for chronic conditions. For pharmacists and the care team, shortages demand time-consuming and often frustrating searches for alternatives. For patients, they result in the stress and harm of delayed treatments and surgeries. For governments, they increase healthcare expenditures to acquire the scarce products or their replacements from other sources or innovator substitutes. Some studies have shown that drug shortages might lead to illness and even premature death (Metzger, Billett, and Link 2012; United States 2015). In this Commentary, we examine the size of the drug shortage problem in Canada between 2010 and 2017, scan the stated reasons for shortages internationally, and look at various proposed solutions. Approximately 1,000 shortages have been reported annually, affecting 1,250 products during a recent three-year period. Indeed, the number of shortages appears to be increasing, although this apparent rise might be explained by growing pressure to adhere to the policy of mandatory notification introduced in 2016, even if its enforcement is still lacking. The majority (77 percent) of drug shortages involve generic drugs, although a significant proportion (23 percent) also affected innovator drugs. These figures correspond to the relative prescription volume of generic and innovator drugs. Several surveys by pharmacists, physicians and various specialties have documented the extent of the drug shortage affecting the majority of practitioners in every province, and find it present over a wide array of products (Canadian Pharmacists Association 2010, 2011; Hall et al. 2013; Sullivan 2014). The precise causes of Canadian drug shortages are unknown and little has been done to conduct root-cause analysis or explore the consequences of Canada’s limited capacity to supply its needs for medicines with locally manufactured active ingredients and finished products. Drug shortages are a global problem, although their manifestations vary among countries. Most countries do not measure them, but media sources report on individual crises as they emerge, detailing their effects on pressing health problems. A stable supply solution of a diversity of medicines is necessary to keep healthcare costs down, avoid expensive solutions to sudden emergencies and maintain access to medications for the entire population, including the 10 percent of Canadians who cannot afford their prescription drugs (Law et al. 2012). We hope that regular analysis of the drug shortage problem will generate insight into the extent of the problem, its possible causes and provide a baseline for assessing the effectiveness of policies created to manage and prevent it. We urge Health Canada to provide annual reports on the drug shortage problem in an effort to define it, explain it and, above all, solve it. Only when the causes are identified can solutions be found.