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Notebook Medicine

A new drug war

Quinn Nystrom traveled from Minnesota to purchase insulin at Shoppers Drug Mart pharmacy in Fort Frances, Ontario. (Jerry Holt/Minneapolis Star Tribune via ZUMA Wire/Alamy)

Medicine

A new drug war

U.S. turns to Canada for cheaper drugs, but does Canada have enough to share?

When pharmacist Heather Christ arrived for her afternoon shift at Shoppers Drug Mart in New Brunswick, Canada, she noticed a tower of empty pharmacy trays stacked nearly 2 feet high. The reason, Christ said: shortages. Patients with high blood pressure request a 90-day supply of medicine, but the pharmacist may only give them enough for 10 days. A mom comes to pick up an anti-convulsant for her epileptic child, only to find the drug isn’t available.

When drugstores run out of drugs, “people just get panicky,” says Christ. But that’s nothing new in Canada: Christ sighed heavily and said, “It’s been part of the scenery for so long.” Christ, a 30-year veteran of Canada’s pharmaceutical industry, says the country’s drug shortage has worsened in recent years. More than 1,800 drugs are on Canada’s needed list, according to the official Drug Shortages Canada website.

Last month U.S. President Donald Trump announced plans to allow the import of cheaper prescription drugs from Canada. But Canada doesn’t have enough drugs to share with the massive U.S. market, and the Canadian Health Minister’s office said, “While we’re aware of ongoing state-led initiatives to import Canadian drugs, we weren’t consulted on specifics.”

Given Canada’s preexisting drug shortages, Christ says expanding the market is “alarming from Canada’s point of view.” If the United States drills a hole in the already leaking Canadian drug pipeline, and then tries to fill a tank 10 times the size of Canada’s, the drug supply will run dry. A 2018 study published in the journal Health Economics & Outcome Research: Open Access found that if one-fifth of U.S. prescriptions are filled in Canada, Canada’s drug supply will be exhausted in six months.

Christ says Canadian pharmacists sometimes work around drug shortages by adapting prescriptions. They work from scratch to create alternative compounds. The process takes extra time and keeps patients waiting, but shortages leave them no choice.

Christ is allergic to bees, so she carries an EpiPen. When an EpiPen shortage struck Canada last summer, she didn’t feel right getting a new one. She and many other Canadians kept their expired EpiPens. A drug’s expiration date is the time after which the drug could have lost 10 percent of its potency, so an expired EpiPen might still work. But it might not work, and a severe allergic reaction would be the consequence. Thankfully, Christ didn’t have to find out because the shortage ended.

One year later, Canada is running out of EpiPens again. Pfizer, until recently the only company authorized to provide injectors to Canadians, continued to have manufacturing problems. Ginette Petitpas Taylor, the Canadian health minister, has signed an emergency interim order to allow U.S.-based provider Kaléo to send epinephrine auto-injectors to Canada.

That may sound like an easy solution, but it was complicated. The new injectors didn’t have instructions in French for distribution in Quebec. They operated differently than EpiPens, so pharmacists had to spend extra time teaching patients how to use them. The injectors came in packages of two, so pharmacists had to open the packages to redistribute them one per patient. And Kaléo had to rebuild trust, since it suffered a product recall in 2015.

Why the recurring shortages of other drugs? Opinions abound. Manufacturing and shipping problems. Disruptions in international supply. Discontinued generics in favor of newer, brand-name drugs with greater profits. Lack of suppliers. Government price caps imposed by Canada’s nationalized healthcare system. And the future of Canada’s drug supply? Christ said, “I’m discouraged.” She sees the recurring problems as the new normal: a normal that could be worsened if the United States comes looking for a share.

Comments

  • RC
    Posted: Wed, 08/21/2019 09:28 am

    The supply problem is purely based on economics.

    1. Americans have been buying lower cost drugs from Canada for several decades. Why? When you can save hundreds, and even thousands of dollars, a year buying USA made pharmacy products through Canada, why not do it?

    2. There are Canadian pharmacies (especially over the web) that cater to American customers. The Canadian companies love their USA customers and their dollars.

    3. Bottom line, USA drug manufacturing companies really dislike the Canadian drug distributors cutting into their American (way over priced) market.  So they are going to mess up the Canadian market anyway they can.

  •  phillipW's picture
    phillipW
    Posted: Wed, 08/21/2019 02:41 pm

    Maybe I am looking at this issue from a different view from everyone else, but in my mind I think Americans use way too many drugs, illegal or otherwise.  Rather than trusting in God and submitting to his authority, we're trusting in drug companies to provide us with temporary relief from pain and suffering that comes naturally in a sin filled world.  While millions die a self-inflicted death via heroin and other illegal narcotics, many more millions are destroying their bodies through legal drugs that are prescribed by doctors are are trusted too easily by patients who just assume the doctor is like the Wizard of Oz and knows it all.  Unfortunately, as I see it, when you pull back the curtain, you'll find that the doctor pulling the strings really doesn't solve your problems and you've been suckered into wasting millions of dollars on medications that all come with severe side effects.

    Frankly, I think the general public has so dumbed themselves down that they don't even see the deadly effects that drug manufacturers have inflicted on the American public, all in the name of profit and greed.

    What a sad, sick society we live in where we are so desparate for drugs that we'll cross borders to get them.

  • JACKIE PARFET
    Posted: Thu, 08/22/2019 11:25 am

    Why is no one asking why drugs (often US made) are so much cheaper on both Canada and Mexico? And why are medical services so much cheaper in Mexico, or other countries like Iran (I recently read an article on Medical Tourism... maybe in the San Diego Union?) I have read that Iran is the place many Europeans travel to for cosmetic surgery...