Shortages of some commonly used medications are spreading across the country and are not expected to resolve until at least the new year, forcing pharmacists and patients to seek alternative solutions.
The ongoing shortage of Lenoltec No. 4, the generic version of Tylenol 4 (also known as T4), as well as Ozempic, a drug widely used for type 2 diabetes, has lasted for several months. Some pharmacists are increasingly concerned about the growing challenge of meeting demand for these essential medicines.
“Certainly the shortages reported by manufacturers are impacting all of Canada,” said Jody Shkrobot, clinical assistant professor in the Faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta.
But some regions of Canada could see greater shortages, he explained.
“You might see a pharmacy with little product because they don’t have a lot of patients using that medication, versus another pharmacy that has found itself in situations where it can’t supply its patients “, did he declare.
High demand leads to shortage of diabetes drugs
Lenoltec No. 4 is a narcotic painkiller that has been in short supply since April 19, 2023, when the issue was first reported to the Canadian Drug Shortage Database. Teva Canada, the pharmaceutical company that makes this generic drug, said it estimates the shortage will last until January 10, 2024, according to the Canadian Drug Shortage Database.
Global News contacted Teva Canada to inquire about the cause of the supply shortage, but did not receive a response at the time of publication.
On the Canadian drug shortage website, the company said the reason for the shortage was “a disruption in the manufacturing of the drug.”
The shortage of Novo Nordisk’s diabetes drug Ozempic (the one-milligram injector pens) began on August 21, 2023 and is expected to be resolved by March 21, 2024, according to the Drug Shortage Database. The limited supply of this product is due to a manufacturing shortage of the plastic used to make the injector pens the drug comes in, coupled with growing global demand for the drug, according to the company.
“Once a shortage has existed for a period of time, it doesn’t take very long before the supply chain is depleted because, for the most part, pharmacies and wholesalers operate on somewhat of a fair inventory type process on time. . So once a shortage occurs, it impacts things very quickly,” Shkrobot said.
“The list is getting longer and longer”
The shortage of painkillers and Ozempic was first reported by Global News on Wednesday.
Pharmacists in Edmonton say they are facing a shortage of the drugs and one told Global News it’s the worst she’s seen in her career.
“It’s actually been two or three months longer now, but because the list is getting longer and longer,” said Ghada Haggag, pharmacy manager at All Care Pharmacy in Edmonton.
“The drug shortage is becoming more complicated, as outside of pharmacies we can control. That’s why it’s a bigger problem now. It’s so much,” she told Global News earlier this week, adding that in her 23 years as a pharmacist, she had never seen such a large backlog.
Distribution of diabetes drug Ozempic is limited
But Shkrobot said the shortage isn’t limited to Edmonton.
“The problems we face in pharmaceutical supply are generally not just domestic. So Alberta — Edmonton — It’s not unique in terms of the situations we see for certain medications,” he said.
In an email to Global News on Wednesday, a Health Canada spokesperson said drug shortages are reported by their manufacturers on Canada’s mandatory drug shortage and discontinuation reporting website.
“Another step we are taking is to work with manufacturers to arrange the importation of drugs from other countries to help fill Canada’s supply gap. This helps improve access to supply until the Canadian drug is available again,” the spokesperson said.
What are the alternatives ?
Lenoltec No. 4, or Tylenol 4, is primarily used as a pain reliever and contains a fairly high level of codeine, Shkrobot explained.
“It’s for pain that’s going to be a little more intense,” he said.
Since the drug includes two widely available ingredients, acetaminophen and codeine, he said the shortage made finding suitable substitutes a relatively manageable task.
But he added that it’s always possible that a person’s body absorbs things slightly differently when you change medications.
“So we can’t say that they will be 100 percent interchangeable, but you can get equivalent doses of these two agents,” Shkrobot explained. “It’s not as convenient to have to take them, two tablets versus one.”
Kyro Maseh, a Toronto-based pharmacist, said his pharmacy has been out of the generic drug Tylenol 4 for months, but he said the shortage is still “manageable.” He said he was able to offer alternative solutions to his customers and no one had yet complained about the replacement.
However, Maseh said the Ozempic shortage is by far a bigger problem because there aren’t many alternatives to the drug.
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“It’s an extremely effective (drug), it solves a whole range of problems for patients, not just diabetes, but also weight loss, blood pressure, their blood sugar is controlled. It doesn’t cause hypoglycemia like insulin does,” he said.
“The medicine is out of stock and there are a few similar medicines that can be substituted,” adding that substitutes are covered by the government, meaning many of his patients have to pay out of pocket.
For example, he said that in Ontario, the province would help cover the cost of Ozempic for many diabetic patients. But for alternative mediation, like Mounjaro, he said this is not covered.
He said his pharmacy sees many customers who are over 65 and on welfare, meaning many struggle to afford alternatives.
“The cost can vary between $250 and $550 per month,” Maseh said. “And the only other alternative is to increase their insulin and that comes with risks.”
When will the shortages be resolved?
While Novo Novartis says the Ozempic shortage should be resolved by March 2024, Masch remains skeptical and isn’t holding his breath.
“It was supposed to be out of stock until November,” he said. “So from time to time our pharmacy is allowed to order one or two (injector pens). But to put it in perspective, we could give out 12 a day.
Until the back order is filled, he said he spends much of his time “triaging patients” to treat people with more severe diabetes.
Allison Bodnar, The CEO of the Pharmacy Association of Nova Scotia said drug shortages like those seen with Ozempic and generic Tylenol 4 are unfortunately a new reality in Canada.
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“There doesn’t seem to be much respite these days for pharmacists,” she said, noting that shortages come from a variety of reasons, including insufficient supply, shortage of raw materials, manufacturing issues or increased demand.
A spokesperson for the Canadian Pharmacists Association echoed the sentiment.
“Unfortunately, drug shortages are common across the country and pharmacists have to deal with what happens on a daily basis,” Tyler Gogo said in an email to Global News on Thursday.
Although substitutes for these medications are available, there are situations where even supplements experience shortages. Bodnar describes this phenomenon as a “cascading shortage,” which is when pharmacists also quickly exhaust alternative options.
As patients wait for their prescribed medications, like generic Tylenol 4 or Ozempic, to return to the market, she said it’s crucial for them to talk with their pharmacists and doctors if they have any concerns. concerns about drug supplies.
“I think the other pieces are not to be accumulated,” she added. “Don’t take more than you need. Generally speaking, supplies are coming back into play.”
— With files from Jasmine King and Katherine Ward of Global News