Water, water everywhere, but not a drop in sight: the impact of drug shortages on Canadian anesthesia care

Abstract

A 38-yr-old mother of three presents for a laparoscopic appendectomy for acute appendicitis. She is a non-smoker and has a history of motion sickness. Her attending anesthesiologist advises her that she is at high risk for postoperative nausea and vomiting and that the most commonly used intravenous antiemetics are currently unavailable. The patient develops intractable vomiting in the postoperative care unit and requires three days of hospitalization as a result of a gastrointestinal hemorrhage secondary to a Mallory-Weiss type esophageal injury. Both the anesthesiologist and the patient are upset over the outcome of the anesthetic care. Although this is a fictitious case, in April of 2012, this type of scenario was very possible in institutions across Canada. In the survey of Canadian anesthesiologists reported by Hall et al. in this issue of the Journal, 53 (20.6%) of the 258 respondents during April 15 to June 4, 2012 noted a shortage of antiemetic agents. Shortages of anesthetic agents have been reported to cause life-threatening illness. During the 2010 propofol shortage in the United States, contamination of propofol single-use vials used inappropriately for multiple patients led to an outbreak of hepatitis C infection and the need for approximately 40,000 patients to be tested for potential infection. The global pharmaceutical market is valued in excess of US$880 billion dollars. Canadian pharmaceutical sales had an annual growth of 6.4% per year over the period 2006 to 2010, and Canada is the fourth fastest growing pharmaceutical market globally. In spite of this growth in the pharmaceutical industry, over this same period, drug shortages have become an increasingly serious and prevalent problem in Canada and internationally. Since 2009, the Canadian Anesthesiologists’ Society (CAS) has lobbied the federal government to work in cooperation with provincial and territorial governments and industry to a) develop a nationwide strategy to anticipate, identify, and manage shortages of essential medications; b) mandate that drug manufacturers report any planned disruption or discontinuation in production to Health Canada in a timely manner; and c) expedite the review process to ensure that safe and effective medications are made available to the Canadian public. This initiative was championed by CAS Past President, Dr. Richard Chisholm. In March 2012, Dr. Chisholm gave a presentation on drug shortages to the House of Commons Standing Committee on Health on behalf of the CAS. In June 2012, this committee tabled a report, Drug Supply in Canada: a Multi-Stakeholder Responsibility. The recommendations in this report are well aligned with those of the CAS, but as yet, the federal government has not moved