CRITICAL DRUGS COALITION

We are in this

together.

The Critical Drugs Coalition is a group of Canadians concerned about the shortages of drugs desperately needed in critical care settings in the fight against COVID-19. We are not only physicians and pharmacists, but are also parents, children, grandchildren and neighbours concerned about our loved ones and fellow citizens.

We, the Critical Drugs Coalition, are a collective of physicians and pharmacists concerned about the growing, complex issue of drug shortages in Canada. These shortages have existed for the past decade but have been greatly exacerbated due to the COVID-19 pandemic. While our Intensive Care Units (ICUs) are thankfully seeing fewer COVID-19 patients, the pandemic has been placing a heavy burden on the drug supply of ICUs, where patients often require weeks’ worth of treatment on ventilators. At this time we are concerned about shortages with the anticipated second wave of the pandemic. 

• As frontline pharmacists and physicians have told us (and many of us have first hand observed) there are shortages of essential and critical care medications such as propofol, ketamine, succinylcholine, fentanyl, midazolam and more. These drugs are essential in the treatment  of COVID-19 patients in critical care. These drugs are also used in ORs, ERs and palliative care wards. Their shortages imperil the lives of patients seeking care all over the country. 

• Currently, the vast majority (15/24) of the drugs on the Health Canada’s own Tier 3 list are essential for treating COVID-19. The Tier 3 list is designated for drugs that are experiencing an active significant shortage with no available alternatives to fulfill that shortage. With the likely upcoming second wave in Canada, the potential for further exacerbation of these shortages is inevitable unless we implement rigorous preparedness measures. We have also witnessed shortages in antibiotic drugs, some of which are on the Tier 3 list, such as Penicillin G.* 

• Research has demonstrated the dire ramifications of drug shortage on our patients, putting their lives at risk and compromising the optimal care for their health. Altogether, these concerns call for immediate action, primarily by our governments on all levels, federal, provincial, territorial, and municipal. We simply cannot afford to jeopardize the lives and wellbeing of our patients due to an inadequate supply of critical drugs. 

Many of the critical care drugs should be part of the National Strategic Emergency Stockpile. However, it is clear that Canada simply did not have enough stockpiled to meet the demand during the COVID-19 pandemic and that there has been under allocation and underspending for the emergency stockpile. In order for the stockpiling strategy to be effective, it is vital that the federal, provincial, and territorial governments work closely with hospitals nationwide to establish a comprehensive list of essential medications for hospital-based care, as well as develop a plan to procure medications in a coordinated manner to prevent unintended competition for resources. 

We are aware of active efforts by Health Canada and provincial Health Ministries to resolve current shortages of Tier 3 drugs, or projected ones through its Tier Assignment Process. Furthermore, Ontario has a Critical Care COVID-19 Command Centre and has created a Critical Care Drug Shortage Task Team. Certainly, the short-term deficit will need to be resolved through this mechanism and importing from all available suppliers. However, to support the system at large, provincial and territorial governments will need national support. 

Regardless of well-established Federal-Provincial-Territorial dynamics, Canada will perpetually face drug shortages without concrete actions. This is why we recommend that our federal government commits to working on a long-term solution involving a three-pronged strategy:

• A pan-Canadian Critical Medications List which the government commits to ensure are always in stock, particularly in the National Emergency Strategic Stockpile, which potentially could be overseen by the proposed Canada Drug Agency.

  • This allows the parties involved in addressing the drug shortages to have a clear picture of what drugs to monitor closely, and provides a more comprehensive approach to the problem.

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• A publicly owned generic, critical drugs manufacturer, or at the bare minimum, public support for spare capacity by Canadian-based and controlled drug manufacturers to be used for critical drugs.

  • This manufacturer or manufacturers would specialize in manufacturing the critical drugs on the Critical Medications List, and would be primarily involved in satisfying significant portions of our national demands.    
     

• Greater transparency and communications from governments to the health sector and general public around the supply of critical medicines:

  • This ensures that drug supply issues are addressed well before they pose any serious hurdles to very sick patients. 

We encourage our government to give this urgent issue attention and efforts now, so that Canadians can have the confidence that their healthcare system will be there when they most need it.

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Sincerely,

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National Representative Bodies: 

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1- Canadian Association of Emergency Physicians

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2- Canadian Doctors for Medicare

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3- Canadian Federation of Medical Students

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4- Critical Drugs Coalition

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5- Ontario Medical Association

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6- Society of Rural Physicians of Canada

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7- Best Medicines Coalition

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8- Yukon Medical Association

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9- Doctors Nova Scotia

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Rolling Individual Signatories: 

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1. Abdul Basith, MD CCFP, Emergency Physician at Markham Stouffville Hospital, Founder, Critical Drugs Coalition

2. Alecs Chochinov, MD, FRCPC, President, Canadian Association of Emergency Physicians

3. Amit Arya, MD, CCFP (PC), FCFP, Assistant Clinical Professor, Division of Palliative Care, Faculty of Health Sciences, McMaster University

4. Andrew Gloster, MD, PhD, Chief of Staff, Red Lake Margaret Memorial Cochenour Hospital

5. Carter Thorne, MD FRCPC FACP MACR, Assistant Professor of Medicine, University of Toronto

6. Chris Simpson, BSc, MD, FRCPC, FACC, FHRS, FCCS, FCAHS, Professor, Queens University School of Medicine

7. Danielle Martin, MD CCFP, MPP, Associate Professor, University of Toronto

8. Danyaal Raza, MD CCFP, Chair, Canadian Doctors for Medicare

9. Jacalyn Duffin, MD, PhD, Professor Emerita, Queens University

10. Joel Lexchin, MD, CCFP(EM) FCFP, Professor Emeritus, York University

11. Joshua Tepper, MD FCFP, MPH, MBA, Professor, University of Toronto

12. Kashif Pirzada, MD CCFP(EM), Emergency Physician at William Osler Health System and Sunnybrook Health Sciences Centre, Founder Critical Drugs Coalition

13. Melanie Bechard, MD, FRCPC, Pediatric Emergency Medicine, Children’s Hospital of Eastern Ontario (CHEO)

14. Naheed Dosani, MSC, MD, CCFP(PC), Assistant Clinical Professor, McMaster University

15. Nav Persaud, MD, MSc, CCFP, Canada Research Chair in Health Justice, Associate Professor, University of Toronto Department of Family and Community Medicine

16. Philip Baer, MDCM, FRCPC, FACR, President, Ontario Rheumatology Association (ORA)

17. Philip Berger, MD, Associate Professor University of Toronto Faculty of Medicine

18. Rameeka Khan, R.Ph, Clinical Pharmacist at Markham-Stouffville Hospital, Member, Critical Drugs Coalition

19. Saad Ahmed, MD CCFP, Lecturer, University of Toronto, Department of Family & Community Medicine, Founder, Critical Drugs Coalition

20. Sandy Buchman, MD CCFP (PC) FCFP, President, Canadian Medical Association

21. Sara Van Der Loo, MD, FCFP, FRRMS, Chief of Staff, Atikokan General Hospital

22. Sarah Newbery, MD FCFP, Chief of Staff, North of Superior Health Care Group

23. Sean Moore, MD, FRCPC, Assistant Professor, Northern Ontario School of Medicine, Board of Directors, Canadian Association of Emergency Physicians

24. Sohail Gandhi, MD, CCFP, Immediate Past President of the OMA

25. Stephen B Singh, MD, CCFP(PC), Family Physician and Palliative Care Specialist

26. Jon Piptone, MD, Queen’s University

27. Latif Murji, MD, CCFP, University of Toronto

28. Cynthia Leung, PharmD, Queen’s University

29. Michael East, BSc Phm, Kirkland & District Hospital/Englehart & District Hospital

30. Michael Taglione, MD, MSc Candidate, University of Toronto

31. Joshua Tepper, MD, University of Toronto

32. Rex Park, BHSc, MD Candidate, Queen’s University

33. Sara Van Der Loo, MD, FCFP, FRRMS, Chief of Staff Atikokan General Hospital

34. Milena Vassileva, MBA, University of Toronto

35. Melanie Bechard, MD, University of Ottawa

36. Priscilla Po, PharmD, University of Toronto

37. Zana Alai, MD, University of Manitoba, 

38. Andrea Mariscal, MD, PhD, University of Toronto

39. Christine Cserti-Gazdewich, MD, University of Toronto

40. Jody Mugford, BSc Pharm, PharmD candidate, Dalhousie University, University of Toronto

41. Arif Aziz, HBSc, PhD, MBA, University of Toronto

42. Silvia Deng, RPh, Markham Stouffville Hospital

43. John Adams, Best Medicines Coalition, Canadian PKU & Allied Disorders

44. Linda Guo, RPh, Markham Stouffville Hospital 

45. Pavan Bagri, BSc Pharm, PharmD Candidate, Halton Healthcare

46. Nicole Schau, BSc Phm, RPh

47. Kamal Powar, PharmD, Halton Healthcare

48. Sana Azmathunnisa, BComm, Osmania university

49. Kim Hartley, Pharmacy Sales/Educator, Pfizer/Pendopharm/mulitple generic Rx - Mint

50. Ryan Modafferi, BSc, DDS Candidate, Brock University, University of Toronto

51. Katie Kraayenbrink, RN, University of Windsor

52. Kaitlin Pattrick, MD, Resident Doctor, University of Toronto

53. Hayman Buwaneswaran Buwan, MD, Physical Medicine and Rehabilitation, University of Toronto

54. Jesse Zroback, MD, CCFP (EM), Northern Ontario School of Medicine, University of British Columbia, Memorial University of Newfoundland

55. Saad Ansari, MD, Resident Doctor, University of British Colombia 

56. Shivani Felicia Chandrakumar, MD, University of Toronto

57. Gurmakh Singh, BSc Pharmacy, Halton Healthcare

58. Phyllis Diller Stewart, University of Toronto

59. Trevor Morey, MD, CCFP (PC), Inner City Health Associates

60. Sandy J. Murray, MD, Community Physician

61. Ryan Warshawski, MD, CCFP, Yukon Medical Association Acting President

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*These numbers are current as of August 13th 2020 and are subject to change as the shortages are regularly monitored by Health Canada. Please visit Health Canada's website for the most up to date numbers here.