Drug shortages in New Brunswick are real and we all must do our part to prevent more
By Sam Lanctin
The principal object and duty of the New Brunswick College of Pharmacists is to promote and protect the health and wellbeing of the public, in collaboration with other health disciplines. In other words, we work to ensure the wellbeing of the public through regulation of pharmacists, pharmacy technicians and the profession of pharmacy. Additionally, it is in our legislated authority to ensure the safe, rational and effective use of legalized drugs and related devices, according to the New Brunswick Pharmacy Act, 2014.
On April 23, the Government of New Brunswick’s All-Party Cabinet Committee on COVID-19 unilaterally revoked the New Brunswick College of Pharmacist’s order of March 16 limiting prescription refills in the province to 30 days. This change came in spite of the fact that, in mid-March, the demand for prescription drugs increased more than 200% in Canada as a result of the public feeling the need to stockpile medications resulting in even further shortages.
Many other professional governing bodies and jurisdictions around the world have also adopted or recommended temporary 30-day limits on prescriptions in order to stabilize the supply chain during the COVID-19 crisis, including in North America, Europe and Australia. Now, New Brunswick seems to be one of the only jurisdictions in Canada to ignore the dangers and warnings from supply chain experts. To say the least, this is unfortunate.
These experts include the Canadian Association for Pharmacy Distribution Management which, as recently as April 9, stated, “The shift from 90-day prescription refills to 30-day enables the broader pharmaceutical supply chain community to better manage supply. These are necessary measures to effectively counter the substantial increase in demand and protect supply for Canadians in the short and medium-term.”
Distributors have told us in very clear terms that temporary 30-day limits help. It’s understandable, given that many of the ingredients used in drug manufacturing are sourced from China and India, where COVID-19 has caused chaos with production and transportation.
On a daily basis, pharmacists are shorted on their orders from distributors because product is just not available. As well, many people reading this have likely had prescriptions partially filled because the pharmacy cannot obtain product. There is even a national website that tracks drug shortages: www.drugshortages.ca.
After repeatedly explaining these facts to government, we kept hearing back, “There is no evidence of drug shortages in New Brunswick”. Also, patients have been quoting our government officials who said as much during the Premier’s Thursday briefing last week. It was – and is – very frustrating to deal with.
We acknowledge that costs for some individuals increased with the 30-day refill directive. To help the most vulnerable in our society, including low-income seniors and other New Brunswickers in need of assistance, the government stepped up early to cover their co-pays. It was the right thing to do in support of a temporary measure during extraordinary times and we give the government its due credit on this. In all respects, the government’s efforts to put this help in place for those in need appeared to the College as an acknowledgement of the 30-day supply restriction.
Other patients not covered under the New Brunswick Drug Plans (who are either without a drug plan or on a private insurance plan) were required to pay the full co-pay for each refill. The 30-day restriction was intended to be temporary and while this caused financial strain and additional stress for some patients, pharmacies were following the directive of the College and thus acting in the best interest of the greater public during this pandemic crisis.
Pharmacy staff, meanwhile, were accused of price gouging, were verbally accosted and even had items thrown at them by irate patients. Pharmacists care deeply about their patients and did what they could to support and accommodate them. Pharmacists and pharmacy technicians have been on the front lines of the COVID-19 pandemic since day one. Pharmacy teams were working very long hours with many offering delivery service at their own expense or making arrangements for curbside pick-up – in addition to the usual free-of-charge counselling offered to patients and managing shortages on drug supply orders.
At this time, New Brunswickers need to understand that 90-day refills will be impossible for many drugs now and quite possibly into the long-term future. The College and pharmacists across this province have an ethical and professional duty to continue to closely monitor supplies. Where possible and appropriate, pharmacists have been asked to comply with the 90-day refill order. Where not possible, pharmacies will have to restrict refills on drugs experiencing shortages. Pharmacies simply cannot create drugs out of thin air when there are none to be had from a drug distributor.
Meanwhile, I would ask that those New Brunswickers who can, please continue to voluntarily ask for 30-day refills instead of 90. This will help us do our part as a province in stabilizing the drug supply chain. We realize that not everyone will be able to do this, but if you can, it would be a big help.
The New Brunswick College of Pharmacists has an ethical responsibility in trying to avoid future drug shortages; fulfilling that role has been blocked, however. Let me be very clear, the New Brunswick College of Pharmacists stands behind our previous decision to direct pharmacists to temporarily limit refills to 30-day supplies. It was – and still is – the best and correct avenue based on data and the opinions of experts.
Let there be no doubt, the provincial government and the All-Party Cabinet Committee on COVID-19 – which includes all party leaders – have taken on the full responsibility for the negative impacts that the ever-weakening drug supply chain will continue to have on New Brunswick for the weeks, months and possibly years to come. The goal of our valid restrictions was to pro-actively protect the supply chain from further damage. That right has now been taken away from us. Once a shortage starts, it’s too late.
In closing, I offer my sincere thanks to all the other frontline workers in New Brunswick – in addition to those in pharmacies – for doing an excellent job during this pandemic in often very stressful conditions.
Sam Lanctin is the Registrar of the New Brunswick College of Pharmacists.