What is a drug shortage?
A shortage is a situation in which the manufacturer is unable to meet the demand for the drug1. If a drug manufacturer anticipates that it will experience delays in supplying pharmacies with a medication, the company will report this as a drug shortage to Health Canada and it will be posted on the Canadian Drug Shortage website: www.drugshortages.ca.2 This is a requirement in Canada since 2017 in order to enhance tracking of and responsiveness to drug shortages. You may already know that drug shortages are not a new concern and constitute a worldwide issue, but in light of the COVID-19 pandemic, we are seeing an exacerbation of this problem. Last year, the Canadian Pharmacists Association said manufacturers reported about five new drug shortages per day in Canada. By early April 2020, that increased to 16 a day3.
What medications are in short supply in Canada due to COVID-19?
Health Canada has listed all the current Tier 3 shortages on their website (see actual and recent list right here).4
Drugs that are in short supply, that most likely concern you, are salbutamol metered-dose inhalers (MDI)5, also known by the brand name Ventolin® or sometimes the “blue inhaler” or ”rescue inhaler”. These medications act by expanding (dilating) the airways allowing a person to breathe more easily. They are usually part of your ”Action Plan”.
What do we mean by Tier 3 shortages?
Here is a definition of Tier 1, 2 and 3 shortages:
Tier 1 shortage
Anticipated drug shortage
Tier 2 shortage
Actual drug shortage
A shortage with the greatest potential impact
on Canadians whereby there are no available
therapeutic alternatives marketed in Canada
Why do drug shortages occur?
On a global scale, drug shortages can occur for numerous reasons. Problems can occur at any point in the drug supply chain6, for example, there can be a chain disruption, fewer manufacturers, a natural disaster (a global pandemic!), or an increased demand of the drug. Over the last several years, the manufacturing of drugs has been moved to factories in places like China and India, the goal being to reduce costs. While some drugs are assembled in Canada, none are completely manufactured here from start to finish.
Concerning the salbutamol inhalers, the main issue seems to have been a surge in global demand during the pandemic. In the first three weeks of March 2020, there was a three-fold increase in the demand for this inhaler in Canada. It is possible that the spike in demand relates to patient and organizations stockpiling in projection of actual needs. These inhalers are also being used increasingly in hospitals for patients who require bronchodilator therapy since the use of inhalers to deliver salbutamol is preferred as opposed to delivering this drug by nebulizer, contrary to what is often done. This is because of safety issues during the Covid-19 pandemic which we will be discussing in our next blog.
Measures to control the drug shortages
The Canadian Pharmacists Association has encouraged its members to limit patients to a one-month supply of their prescriptions until the drug shortages are resolved. The reason behind this is that pharmacists only have access to a limited supply of drugs. For example, a pharmacy may order ten inhalers, but it only receives two from the warehouse. The pharmacist must then choose to give two inhalers to one patient, or one inhaler each to two patients.
Since April 23rd, the Quebec government had instructed pharmacists to substitute salbutamol for other medications, but this instruction was suspended on May 8th because supplies of salbutamol have improved in recent weeks.
By the Canadian Thoracic Society
The Canadian Thoracic Society has developed mitigation strategies for an emerging salbutamol inhaler shortage in Canada during the COVID-19 pandemic7,8. Your physician or pharmacist will be able to substitute your medication for an equivalent in the meantime, if needed.
By Health Canada
Since May 13th, Health Canada has permitted the exceptional importation of UK-labelled salbutamol. Both Canadian and UK-labelled salbutamol inhalers are used in a comparable way. Your pharmacist or other healthcare professional will inform you if you are receiving a UK-labelled product9.
In summary - What you can do
Continue taking your regular medication for the maintenance of your respiratory condition as prescribed. This will ensure that your lungs are working at their best and reduce your need for salbutamol to relieve acute symptoms.
About the author
Dr. Josianne Hamel Bourbeau completed her medical studies and her specialization in family medicine at the University of Montreal. Her practice is versatile and diverse, as are her interests. She currently works at the GMF Ahunstic and at the Centre d’hébergement Notre-Dame-de-la-Merci in the CIUSSS du Nord-de-l’Île-de-Montréal, and at the Saint-Eustache Hospital in the CIUSSS des Laurentides. She is also involved in hospital teaching for undergraduate medical students for the University of Montreal. She firmly believes in the power of sharing medical knowledge to patients and between professionals in order to provide sustainable quality health care for all.