drug demand is another curve to be flattened

there is a second curve that needs to be flattened during the covid-19 pandemic — the steep increase in the demand for prescription drugs, a frenzy that has aggravated the daily drug shortages plaguing the healthcare system.“we’ve taken steps to flatten the demand curve so everybody gets access to prescription drugs,” says daniel chiasson, president and ceo, canadian association for pharmacy distribution management (capdm).limiting prescription fills to 30-day supplies has been one of the steps taken across the country as a strategy designed to preserve the nation’s drug stock.while prescription drug shortages occur daily in canada, the pandemic has resulted in twice the number of reported drug shortages, according to barry power, senior director, canadian pharmacists association (cpa).these shortages pose a risk to both patients with covid-19, as well as those with chronic medical conditions such as rheumatoid arthritis, asthma and diabetes, and have led to concerted efforts to minimize negative effects on canadians.

drug shortages common

few canadians are aware that shortages of prescription drugs are commonplace. a survey last year by the canadian pharmacists association pre-covid revealed that pharmacies spend about 1.5 days of each work week simply dealing with drug shortage issues.canada’s drug supply chain struggles through a complex maze of manufacturing and distribution restrictions and obstacles. even experts have difficulty tracing a drug from its active chemical ingredient to its finished, packaged form on the shelf of the local pharmacy or hospital.shortages result from higher than anticipated demand for pharmaceuticals, decreased supply, and regulatory factors that impact the manufacturing, distribution, and consumption of drug products.the covid-19 pandemic has increased clinical demand for specific drugs, such as sedatives and muscle relaxants, commonly used in intensive care units where critically ill patients with covid are hospitalized. there is also a greater need for drugs used for palliative care, like morphine and midazolam. antibiotics required to treat infections that accompany or follow viral illnesses — for example, intravenous agents such as tazocin and ceftriaxone — are also in higher demand.consumers have also played a role in shortages of certain drugs. power says that in march, when governments started imposing lockdowns and closures to stem the pandemic, there was a huge rush to pharmacies as people tried to secure medications, with some requesting six-month supplies.stockpiling by patients “wiped out inventories at the pharmacy level,” says chiasson. “it created tremendous inequity in terms of patients being able to access the medication they needed.”this prompted the cpa and other pharmacy stakeholders to recommend a one-month supply limit of  medications to prevent shortages — a directive that was implemented in most provinces, but met with some public concern regarding patients being required to pay multiple pharmacy dispensing fees.shortages can also result from unanticipated demand for drugs that have suddenly attained a spotlight, such as the anti-rheumatic drug hydroxychloroquine. american president donald trump famously promoted this drug as a treatment for covid-19, which led to a sharp increase in the number of prescriptions.other shortages have occurred due to changes in medical practice and clinical protocols that then result in higher demand for alternative products. for example, hospitals switched from using a salbutamol nebulizer solution, commonly used for asthma, to salbutamol meter-dosed inhalers to decrease aerosolization and labour-intensive procedures associated with nebulizer usage. ultimately, a domino effect resulted in shortages of inhalers for people with asthma.while it’s clear that excessive or unanticipated demand for specific drugs can result in drug shortage, but there is another side to the equation — that of supply.canadians are dependent on a global supply chain: up to 80 per cent of all drugs for the canadian market are manufactured overseas, either wholly or partially, mainly in india and china. when covid-19 disrupted operations in these countries, canada saw drug production problems. january’s lockdown in china resulted in the drug shortages we are seeing in canada now.other international events over which canada has no control, such as fires, labour disputes, border closings, and freight restrictions can also limit the flow of drugs into the country.drugs manufactured by a single company, or that have few alternatives, are particularly vulnerable to shortages due to such unforeseen events.and since canada has very little capacity to manufacture pharmaceuticals completely within its borders, at least one step in the manufacturing process typically involves accessing global resources and markets. this has resulted in canada being dependent upon globalization to ensure access to prescription medications.beyond demand and supply issues, regulatory factors play a role in how well our drug supply chain functions. routine inspections of manufacturing factories identify quality control concerns that can shut down drug production until problems are addressed. the economics of the pharmaceutical industry can lead companies to cease production of drugs that are no longer profitable, even if those drugs are necessary for patients’ health. patent protection limits which manufacturers can produce which drugs in which country. government regulations for product labelling, such as using the french language, affect product availability.one key mechanism currently in place to manage the drug supply chain is health canada’s requirement for mandatory reporting of both anticipated, and actual, drug shortages by pharmaceutical companies to a national website, which then alerts manufacturers, distributors, pharmacies and hospitals. chiasson says the players then attempt to determine drug demand, and put available inventory on allocation. “we need to put [more] mechanisms in place that would trigger some sort of rationing along the whole chain. because we’re going to continue having these types of problems,” says power.chiasson says that increased domestic capacity to produce drugs within canada would help minimize drug shortages, but such efforts would involve significant economic, political, and social considerations. enhanced inventories of essential medications along multiple points in the supply chain would provide a larger buffer in the system. economic realities of manufacturers, distributors, and ultimately consumers, would need to be addressed. national pharmacare strategies potentially could facilitate drug access for canadians, but in the short term, “it’s very difficult because everybody’s faced with the same covid-19 pandemic and everybody’s experiencing the same demand spikes,” says chiasson.power’s message to consumers: “pharmacies can deliver your prescriptions. get what drugs you need. leave some behind [for others]. we’re all in this together.” alan taniguchi is a fellow in global journalism at the dalla lana school of public health, university of toronto