With COVID cases skyrocketing and hospital admissions rising, Ontario’s doctors warn that the province may once again face serious drug shortages.
The onset of the pandemic in early 2020 raised concerns about securing sufficient supplies of imported active pharmaceutical ingredients (APIs) from China and India, which supply most of the APIs used in North America. Between early March and mid-June of 2020, Ontario doctors and pharmacists were asked to dispense 30 days or less of medication at a time for Ontario Drug Benefit recipients to ensure there was an adequate supply during the first wave of COVID.
In August, Canada’s doctors and pharmacists wrote to Prime Minister Justin Trudeau, pointing to shortages of essential and critical care medications exacerbated by the pandemic, including propofol, ketamine, succinylcholine, fentanyl, midazolam and more. These drugs are essential in the treatment of COVID-19 patients in critical care and are also used in operating rooms, emergency departments and palliative care settings. Health-care professionals have also seen shortages in antibiotics.
In a white paper released today, A Remedy for Canada’s Drug Shortage Dilemma, the Ontario Medical Association recommends that Canada increase domestic production of essential drugs and that all levels of government work together to ensure a sufficient stockpile of essential medications during the COVID-19 pandemic.
“Chronic drug shortages have worsened during the pandemic and may become even more serious if hospitals become overwhelmed with COVID cases in the coming weeks,” said Dr. Samantha Hill, president of the Ontario Medical Association. “Drug shortages can be catastrophic for patients, causing treatment delays, increased suffering, financial burden and an increased risk of overdose and underdose.”
In addition to increasing domestic drug manufacturing capacity and ensuring a sufficient stockpile of essential drugs, the Ontario Medical Association recommends that:
The Ministry of Health, in collaboration with pharmacy regulators, professional associations and key stakeholders such as hospice and palliative care physicians, should change legislation and policies to allow the safe return and distribution of high-demand unused medications in hospital and community settings, including Medical Assistance in Dying kits and symptom relief kits used in palliative care.
The province work with doctors, pharmacists, and other stakeholders to expand community programs to minimize the waste of drugs and support vulnerable populations that have difficulty accessing needed medications.
An ethical decision-making framework be adopted across the province to guide the allocation of drugs to patients during the pandemic and beyond.
Federal, provincial and territorial governments should work with the OMA, the Ontario Pharmacists Association, the Ontario Hospital Association, the Canadian Association of Pharmaceutical Distribution, Group Purchasing Organizations, Innovative Medicine Canada and the Canadian Generic Pharmaceutical Association to develop a centralized drug supply monitoring system to provide real-time updates on community drug supply and distribution, including reasons for and anticipated duration of shortages.
The OMA recommendations are based on lessons learned from the first wave of the pandemic, which did not overwhelm Ontario hospitals. Taking immediate action to address drug shortages is now more important than ever, as projections indicate increased cases and hospitalizations in the coming weeks.
“Drug shortages seriously affect patient care and can force health-care providers to make very difficult choices,” said OMA CEO Allan O’Dette. “Mitigating and managing these shortages will require bold and innovative solutions and the full partnership, attention and commitment of doctors, pharmacists, private and public drug plans, regulators and governments.”
