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Guide Health: Drug shortages

A multiple of factors can lead to a shortage in medications

Reading Time: 3 minutes

Published: November 4, 2022

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When a particular medicine is in short supply, it’s important not to stockpile because this will compound the shortage.

The news these days often brings us reports of drug shortages, but sometimes we don’t hear about them until we’re at the pharmacy counter, expecting to pick up our prescription.

At one time drug shortages were uncommon, but we should keep in mind that, historically, there were fewer drugs than we have today, as well as fewer drugs that have very specialized functions. 

A recent report in the Canadian Medical Association Journal says 45 per cent of the drugs in Canada have had at least one shortage in the past five years. The association also anticipates that drug shortages are going to become even more common.

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Health Canada even puts them in categories. “Tier 1” is an anticipated shortage; “Tier 2” means supply is less than demand..

However, it is the “Tier 3” shortages that are the big concern. These have the greatest impact on the health of Canadians because Tier 3 indicates there are limited supplies of alternative drugs or access to alternate therapies.

Drug manufacturers have a mandatory reporting requirement for drug shortages and Health Canada does track these at drugshortagescanada.ca. Anyone can search the web site for specific drugs.

The reasons for drug shortages are varied. They may arise from a shipping or supply chain problem for either the drug itself or for ingredients that go into the drug. Problems with product quality can include contamination or stability issues, which means that a drug may be recalled and not supplied again until the quality control issues have be rectified.

Often, business reasons may dictate whether a drug is manufactured at all, and in what quantity. When one drug is in short supply, the demand for another drug may increase and a domino effect can occur with the availability of alternate drugs becoming affected.

However, manufacturing disruptions are the leading cause of shortages, cited in over half of the instances.

If the drug is a combination of two or more active ingredients, then there may be an option to take the ingredients individually. It means you have to swallow two or more tablets rather than one, but that is a minor drawback.

You do need to be cautious about their strengths, however, and you may find you need to take half tablets as a result. Remember to use a pill splitter to break the tablet in half accurately.

If a once-daily extended release formulation is unavailable, changing to a regular release formulation may be a solution. Yes, more tablets may be needed, but therapeutically the same daily dose will be achieved. 

If oral tablets or capsules are short, a liquid formulation may be recommended. Again, although this may be less convenient, the actual dose will be the same.

As always, when changing among tablets, liquids and various strengths, make sure the calculations are done correctly so that the same dose is achieved.

In some cases, there is no equivalent product and an alternative therapy is needed. Staying within the same therapeutic group of medications is ideal. For example, when one of the angiotensin receptor blockers was short, the recommendation was to choose another drug from the same group for blood pressure control.

Sometimes, though, the drug is unique and has no other therapeutic equivalents. In such cases, a reassessment is usually needed in order to select another therapy.

When a drug is short, it is important not to stockpile because this will only compound the overall shortage and the drug may not be used prior to its expiry date. Ideally, knowledge is the best approach, so remember that there are options for drug shortages.

Today, drugs control many conditions that led to deaths in the past. For example, with modern treatments, individuals with diabetes or hypertension often live much longer and they are much healthier. When a drug shortage occurs, an alternative is certainly required!

About The Author

Marie Berry

Contributor

Marie Berry is a lawyer/pharmacist interested in health and education.

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