Alberta hasn't yet followed in the footsteps of Ontario, Quebec or British Columbia with the cancellation of elective surgeries, but the effects of the national drug shortage are still evident in hospitals and pharmacies province-wide.
Injectable drugs are in short – and often critical – supply across the country after leading supplier, Quebec-based Sandoz Canada, slowed production last month with little warning.
"It's an unprecedented drug shortage; it's a national health crisis," said Dr. Scott Paterson, past-president of the section of anaesthesia with the Alberta Medical Association.
Sandoz is the second largest supplier of generic drugs internationally and is the manufacturer and sole supplier of 90 per cent of injectable drugs used in Canadian hospitals. The company manufactures widely used anaesthetics, painkillers, cancer medications and antibiotics.
"Relying on one production plant to produce 90 per cent of injectable drugs, most of which are critical drugs to get, for a country the size of Canada is ridiculous," Paterson said. "If the provincial health ministers were smart, they would be talking with their federal health minister in Ottawa and looking at implementing changes to this current system so we're not in a situation of this crisis again."
Lasting effect
The drug shortage has an immediate effect on anaesthetics, intensive care and emergency medicine and has already prompted surgery cancellations throughout the country. Although Paterson said no surgeries have been cancelled in Alberta, he cautions this may not be the case much longer.
"These are uncharted waters; uncharted territory," he said. "A shortage of this type has never happened before and we are reacting, throughout the province, on a day-by-day basis."
Many hospitals have been forced to use second-choice drugs and are trying to stretch remaining supplies of first-choice drugs to last as long as possible, he said.
The second-choice drugs have been used in the past and Paterson said they are often retired as newer drugs become available. He assured only safe drugs will be used as alternatives.
"This is looking like it will not be a short-term problem but could be a long-term problem that could last for months or to the end of the year," he said.
Emergency care
The Sturgeon Community Hospital is in the same position as hospitals across the province in terms of supply levels, said James Silvius, medical director for pharmacy services with Alberta Health Services (AHS).
Hospitals throughout Alberta are sharing their supply of drugs to ensure patients in all areas have equal access to necessary medications.
"We committed right off the bat, at the beginning of this, that what we would be willing to do was to equalize the supply across the province and keep any particular site from running into a situation or disadvantage," he said.
Silvius said by exercising inventory control and transferring products between hospitals, it has prevented the cancellation of surgeries, although he said he did not know how much longer this would last.
"We're at a level that is just about to become uncomfortable," he said, adding some drugs have just a seven-day supply remaining. "We would like to have more stock behind us than we do at the moment."
Pharmacy woes
Nicole Schettler, pharmacist at Health Select Pharmacy in Tudor Glen Market, said the pharmacy has already experienced difficulties as a result of the shortage — something she expects to get worse over time.
"It's going to be challenging … particularly because with injectable drugs, for the most part, there's not another group that makes it," she said. "We've been able to stay on top of it, but it's certainly problematic, especially when people are on really specialized medications that aren't very common."
The individuals most likely to be affected by the drug shortage on the pharmacy level are palliative care patients, who are more likely to rely on injectable narcotics.
Furry friends affected
The problem isn't isolated to humans with area vet clinics also feeling the effect of the drug shortage.
"At this point, I'm not aware of any specific problems, but if it continues, which we're told it will, there could be," said Duane Landals, registrar with the Alberta Veterinary Medical Association and past-owner of the Morinville Veterinary Clinic.
Many drugs are used on a pet and master alike, with less of the drug needed on most animals, which he said could help to stretch out supplies. In the meantime, clinics are looking into sourcing alternative medications, as well as "compounding" medications.
Landals cautioned that although supplies could last longer, a prolonged drug shortage could prompt the cancellation of surgeries if alternative medications can't be substituted.
Warning prompted slowdown
The reason for the "temporary" slow-down results from "increased investment in strengthening manufacturing compliance," which comes after a warning letter was sent by the United States Food and Drug Administration in November 2011 advising Sandoz Canada to improve production standards.
When the slow-down was already in effect, the manufacturing plant suffered an added blow when fire broke out March 4, halting production completely. Production has since resumed at the slowed rate.
Federal Health Minister Leona Aglukkaq sent a letter to Sandoz Canada at the beginning of the month expressing her disapproval of the abrupt disruption to the supply of many critical drugs.
"Canadians deserve better. I am calling on you to fulfil your commitment to make information on current and potential drug shortages publicly available in a timely manner, as well as to take steps to prevent supply interruptions so that patient health and safety is not compromised," she wrote March 2.
Sandoz Canada responded March 12, saying the company is dedicated to providing high-quality care to patients across the country, adding the company aimed to have drug levels restored "as soon as possible."
No timeline was provided for a replenished stock.
"They had a great deal of lead time and they neglected to tell their clients and customers what was coming down the pipeline and that lead time would have allowed people to possibly have (more) time and be better positioned to source out alternative drug supplies," Paterson said.
