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National EpiPen shortage a concern for local pharmacists

Samer Mikhail, owner of Woolwich Total Health Pharmacy in Elmira, is one of pharmacists affected by the Canada-wide shortage of EpiPens. [Faisal Ali | The Observer]

Health Canada’s warning last week of a country-wide shortage of EpiPen auto-injectors highlighted some of the precariousness of the country’s vital drug supply. The warning stated that the stock in pharmacies will most likely be depleted during the month of August, while stock of EpiPen Jr. auto-injectors were also described as being limited.

The shortage was blamed by Pfizer Canada, the country’s lone supplier of the life-saving medication, on a “manufacturing issue,” with the company saying they were working to bring the drug back to pharmacies as quickly as possible.

“Throughout 2018, there has been limited supply of auto-injectors at wholesalers, distributors and pharmacies in Canada.  Pfizer understands the importance of this medically-necessary medicine to Canadian patients and continues to take action to expedite delivery of product to the market,” said the company in a media statement.

Local pharmacists, however, questioned the country’s reliance on a single vendor to source its EpiPens, suggesting a diversified supply would be better.

“Having a second supplier, that is definitely something we need,” said Raj Patel, pharmacist and owner of Remedy’s Rx Pharmacy in Elmira. “At least two manufacturers. So if somebody’s manufacturing facility has some accident like a fire or something, then the other manufacturers will make sure there is a continuous supply.”

He noted, however, the inherent challenge of safely manufacturing the auto-injector, and the high level of quality needed.

“The medication has to be delivered in an accurate amount, and delivered automatically when we activate it, the device. Now that makes it a little more complicated – more challenging – in terms of automation, and it has to be 100 per cent accurate all the time.”

The sentiment was echoed by a second pharmacist in Elmira, Samer Mikhail.

“In my opinion, unfortunately there is one company only that makes it. And this type of medication is [lifesaving],” said Mikhail, owner of the Woolwich Total Health Pharmacy in Elmira. “I’m not sure if there is a way… that this type of medication should not be depending only on one company. In dealing with a medication that is important and can be urgently needed.”

Instead, Mikhail suggested an alternative supply as a possible solution to avoid future shortages.

“They will not be competing as much as they will be providing a good coverage for the community. Or the idea of having a product like that is to protect our patients from an anaphylactic shock. So when we have only one company and it’s short due to any reason, then we’re jeopardizing our coverage for the people that we care about.”

Mikhail added, however, that the government was limited in how it could control the supply of drugs, while having multiple suppliers of a medication was not a foolproof strategy.

“There are other examples of other drugs in the market that can go on back-order, and you find that it has a shortage. And even when there is more than one company that makes it, sometimes you find that they source it from the same provider,” he noted.

For those depending on the emergency medication to stave off life-threatening allergic reactions, Health Canada is recommending people be prepared to use an expired EpiPen, if necessary.

“In light of the shortage, if you are experiencing an anaphylactic reaction and have only an expired auto-injector, use the expired product and immediately contact 911. Regardless of whether the product is expired, you should get to the nearest hospital as soon as possible following the administration of the product, as instructed in the product labelling,” said Health Canada on their website.

“The supply of EpiPens in the 0.3 mg format is expected to be very limited in pharmacies. EpiPen Jr. (0.15 mg) is reportedly also experiencing shortages, and “the supply is limited and is being carefully managed at the national level.”

The supplier Pfizer Canada, meanwhile, has said that it is seeking to replenish the diminishing stocks as soon as possible.

“Pfizer anticipates the next shipment of EpiPen 0.3 mg to the Canadian market by late August 2018. At which time, limited inventory will be available and will continue to be managed through measured allocation.”

Health Canada is advising Canadians to check the website Drug Shortages Canada for up-to-date information on the situation.

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