CRITICAL DRUGS COALITION

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 COVID19. 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 (24/32) 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.