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Jordan Heath Rawlings
Not since the beginning of this pandemic when my brother snagged me a giant box of toilet paper from Costco, had I felt this sense of relief when I saw it. I did a double take. The shelves at the drug store were full. Not a couple of measly bottles with a sign apologizing. Not just bare, with no sign at all, because we all know what’s going on. No, they were really full. But despite the bounty, purchases were still limited to two packages of children’s pain and fever medication per customer, which makes sense, given everything. Pharmacies are reporting panic buying as children’s fever medications remain in short supply. Checking my wholesaler right now, there are very, very few, if any, options available for us to replenish right now. Empty for kids, there’s nothing. Yeah, and we talked to the pharmacist, and they said that they’re on back order and whenever they’re going to get is when they get it. For months now, this medication has been in short supply or mostly out of supply altogether across the country. Ask any parent who’s had a sick kid and, well, you don’t have to ask them if you know that parent they’ve told you about it. What has emerged as this shortage has ebbed and flowed is a picture of a problem created by a whole host of factors from supply chain issues to illness in the community to import regulations to personal hoarding and inequitable distribution, all of those piling one on top of another. To leave parents with sick children sitting up at night wondering if they need to take them to the emergency room because at least they have medicine there. So the question worth asking here is how did all these factors all coalesce around one specific medication? And oh, wait, actually, I’m sorry, it’s not just the specific medication, it’s a whole bunch of medications. This is just the one you’re hearing about. I’m Jordan Heath-Rawlings. This is The Big Story. Carly Weeks is a health reporter at the Globe and Mail who has been following a shortage of children’s pain medication and other medications that you might not know about. Hey, Carly.
Jordan Heath Rawlings
Hi there.
Jordan Heath Rawlings
I’m just going to start by asking you off the top. I was at the office this week. There’s a little Rexall in the strip mall next door, and I found the shelves full of kids tylenol and I bought some. Does this mean our shortage is over, or is that just me?
Carly Weeks
Just to say the problem is solved forevermore, but I think any parent out there who’s been paying attention knows that the supply still does seem precarious. I think this situation is much improved, and certainly since it’s been on the radar for so many months across the country, it’s not uncommon to now find these products in stock. But we know that there’s still just so much sort of turmoil going on with the supply chain, that it’s hard to say when exactly we’re going to see these issues resolved fully.
Jordan
So can you take us back to the very beginning of this then? When did we start to notice a lack of children’s Tylenol?
Carly Weeks
For sure, but also adult cold and flu medications really going back to the summer, even last spring, there were just so many more viruses being reported in young kids. And certainly in the reporting that I did, I think that that’s part of the reason why it did take some surprise, some people by surprise to see what was going on, because in the summer, springtime, that’s typically when virus season is over. But what we started to see was that the shelves were just being stripped bare. There was a bit of a moment in the summer, and I’m not sure how many people would recall this, when a media report came out saying that a major hospital was basically urging parents to only get these medications by prescription. And this idea that children’s medication was going to be sort of kept from parents unless they could get it prescribed to them, I think exacerbated what was already becoming a shortage. It was sort of that moment where the panic buying and maybe some of that hoarding started to take hold when parents were legitimately afraid they weren’t going to be able to find these medications for their young kids. And things really snowballed and escalated quickly from there. So we headed into the fall where another true virus season peaks started much earlier than expected, and then suddenly there were parents who simply couldn’t find these medications at all. And then we found ourselves in that situation that still continues to an extent today.
Jordan
What are the ramifications of that time, especially in the fall?
Carly Weeks
One of the things that I saw was hospital emergency rooms with sick kids dealing with massive overflows. And I think we talked to a doctor about this and they said part of it is that when you have a kid at home that’s suffering from a bad fever and you have no medication, like things can get scary quickly. So you just take them. That’s right, yeah. Any doctor, any nurse will tell you, even when things are really busy, when in doubt, go to the emergency room. And so when you do have a very sick child and you can’t relieve their symptoms. I really sympathize with anyone in that position. I’ve been there myself, worried about your sick kid in the middle of the night or whatever else. And so the ramifications for that are really huge, not only for the individuals who are affected by that, but it sort of sends that panic level that a bit of an alarm through everyone. Everyone is suddenly then wondering about the precarious nature of our supply chain and how we’re going to make sure that we have confidence going forward that we’re going to be able to take care of our kids. You’ve mentioned the supply chain a couple of times. We’ve also talked about viral seasonality.
Jordan
This is anecdotal, but I recall a lot of people taking pictures of empty shelves at their pharmacies and posting it to social media, sort of using that as proof that there was way more covet around than anyone was telling us about. What do we know about the actual root causes of this shortage? Where did it come from?
Carly Weeks
Yeah, definitely it’s multi-pronged and I think it’s kind of hard to go back and really prove this. But I think that honestly, from the experts that I’ve been speaking to and some officials at Health Canada, I think a lot of that rhetoric that did come out on social media didn’t help. Yeah, it’s scary. It’s scary. And then people are suddenly running out to their pharmacy and everyone, their mother, their father, like the concerned grandparents, aunts and uncles, everyone is trying to get their hands on this stuff. And it’s saying, look at the shelves are bare. And this is not to say that, that people were doing this maliciously on social media, but it feeds into that idea of scarcity. And as soon as we as human beings think something is scarce, we seek it. And so that whole idea there, it kind of exacerbated what was going on. But of course, there are many other root causes to this. So drug shortages have become a very serious and growing problem in Canada for at least a decade. And I think that until it really hits home for people again with something very common, like an over the counter medication for kids, that’s really when everyone starts to take notice. So this problem is not new, but now all of a sudden, it’s affecting everybody. And the ramifications are clear that we need to do something about this. So some of the root causes include things like supply chain issues, which have been exacerbated so much during COVID lack of raw ingredients, contamination, a certain shortage of one material in one area, a plant is at a commission, you name it. These problems are ongoing. And the problem is there’s very little way for sort of our government to guarantee we’re going to have these medications in stock for you because they’re being supplied by private companies.
Jordan
So what did the government do then? When these photos started filling up social media and it became clear that we weren’t sure if we’d be able to get this if our kids needed them?
Carly Weeks
I think that for a long time they were kind of watching and waiting, the situation unfold and not quite sure maybe what action to take. I think there were a lot of discussions going on. They were criticized, rightly or wrongly, perhaps a little bit of both during the summer months and into the fall. What are you doing? What is your response? And I think that there was a lot of discussion that was going on between the government, between the companies producing these medications, and our government kind of pressuring them saying, look, we need more of this pronto. And the company is saying, we can only do so much. We’re ramping things up, but these things take time. And as soon as you know that you’re in shortage, you’re already way behind. It’s going to take weeks or months to ramp up supply. Then what happened was when it became clear that this was becoming a crisis that was spilling over, actually impacting the Prime Minister’s like approval ratings, and he was being attacked for it sort of on a daily basis, that’s when we really started to see more action from Health Canada. That’s when they were importing. They took the step to import medication from the United States and Australia. They basically said, we’re going to expedite these medications coming in. There was, I think, a little bit of back and forth about it’s, our labeling laws that were keeping these medications from coming into the country. That was my next question, was because one of the things that everybody was saying at the time was that, oh, we can’t just grab it from the US. Because our labels have to be in English and French. Yeah, and that’s interesting how that really became one of the defining issues of just how incompetent our bureaucracy is here in Canada. I talked to one of the top advisors or one of the people in charge of Health Canada. It wasn’t the labeling necessarily, or it wasn’t the labeling at all. What they had to do on this end, once the medication got into Canada, they just were going to put a label on it or make that change once the medication got here. So they waived those kinds of requirements for companies to bring the medications in with labels as soon as they could, I guess. But that labeling requirement, I think, took hold because it seemed like such a simple explanation to what is a bit of a more complex, ongoing problem.
Jordan
We mentioned that parents were taking their kids to the hospital or that this stuff might only be available through prescriptions. What are some of the things that pharmacies and doctors can do to help with the shortage that they’ve been doing?
Carly Weeks
And I guess even though it may be easing up a bit, things that parents can look to if they can’t find it wherever they happen to be. I mean, I think it took a while, but once we were several months into this shortage, it became easier for parents to find resources of, here are some alternative things you can do. One thing that came through loud and clear, a lot of people were saying, you don’t need to just medicate a fever if you have a sick child. Don’t medicate them if they seem happy. I mean, my kids have had fevers plenty of times, and they still are. Playing happily. It doesn’t seem to be impacting their mood. You want to medicate the child, not just the symptom. So if your child is unhappy and unwell, give them medication. If they’re okay, you don’t need to give them medication. That’s something that a lot of healthcare experts were trying to convey. The fever is the body’s way of fighting off a virus. So unless your child is comfortable, you don’t need to treat it. That was, I think, a bit mind bending for some people to sort of say, wow, I didn’t know that. Other things you can take an adult sort of version of a medication and then do some compounding at home. This is where it gets a little bit more tricky. And you really do need to consult with a reputable source. It’s like a pharmacist website to figure out sort of the conversion. But you can take a certain dose of a certain medication that’s meant for adults and then translate into something for kids. I’m not going to get into that here, but there’s plenty of credible sources online where people can find that. And I guess thirdly, a lot of health professionals and others were trying to give people good advice on when to take your child to the hospital. Here are the symptoms to look for, and I think that’s so helpful as parents when you’re panicked in the middle of the night. Is my child having trouble breathing or are they just congested? Giving people that step by step here’s exactly what to look for, I think was just really, really helpful for people and hopefully, I think did calm some nerves and keep some people at home safe where they needed to be.
Jordan
You mentioned in particular the dosing of adult meds for kids, blowing people’s minds. I think a lot of people looked at that and thought that, like, that’s not something that should be happening in Canada, or at least not something that they would ever expect to be happening in this country. We’re just not used to that kind of stuff.
Carly Weeks
Totally. And I think that pre pandemic. If someone were to say to us a few years ago, this is the new reality, we wouldn’t have even sort of believed them. But I think we’re in a new world now, like it or not, and supply chain problems are not going away and certainly drug shortages are not going away, which is a bit of a scary thought. And that’s why we need to then consider what else do we need to be doing about this and to guard against those insecurities in the future.
Jordan
So natural follow up question to that, and I remember asking this to epidemiologists around COVID vaccines. Can’t we just make more of this stuff in Canada like we have the technology?
Carly Weeks
This has been a lesson brought home by COVID so many times. It’s been well documented that Canada used to be this vaccine powerhouse. We gave most of the capabilities away and now that has come home to roost, right? I mean, you don’t need something when everything is going well, but in a time of crisis, that’s when you realize the power and value of these things. So I think that there’s certainly just so much more discussion that could and should be happening around domestic supply, making sure we do are able to provide for our population. At the same time, the discussion around even national stockpiles has become, I think, much more relevant and certainly during the shortage of kids fever and pain medication, that’s something that a lot of advocates in the childhood health and wellness space have been advocating for. Make sure there’s a supply of this stuff to treat kids across the country, because what if this was a true situation where this is in short supply everywhere and there are kids who desperately need these medications? So there’s a number of different things that have been proposed that we need to start seriously thinking about what are those things?
Carly Weeks
So the national stockpile is one and really thinking about how we kind of keep those essential medicines in stock, not just those vaccines in case of like a bioterrorism event or PPE for the next pandemic, we saw how inadequate our supplies were in 2020. So thinking a bit more strategically about how we make sure we are preparing ourselves for the next emergency, the next problem. It’s impossible to predict what will happen next, but what do we need to have to make sure we are safe in the event of some sort of, you know, border closures, supply chain disruption, you name it, then that’s where it gets a bit more complicated.
Jordan
Where do we take it from there?
Carly Weeks
Again, we are talking about private companies that are producing these medications for the most part. So when we’re thinking about drug shortages and there have been so many we could list off, thinking back to in the last number of years, how many I’ve reported on in the age old discussion of how you can kind of compel a private company to disclose why certain things are in shortage, it’s difficult to even find other reasons. Make sure that things are still being supplied to your country. These are things that are not easy to do. We’re talking about complex networks of raw ingredients that are being supplied by one company and one manufacturer given to another, made in a whole other place. This is a very complex undertaking and I think that federal government level, these things get talked about, the crisis goes away and we kind of forget about it until the next crisis. And I think that there does need to be some kind of, maybe even an international putting heads together to figure out how we can make sure essential medicines stay in stock.
Jordan
So now that the imports have started to trickle in and you can find this stuff in places I know I can find some at a Rexol in downtown Toronto. Is it equitable the way that it’s being restocked? Like, it’s one thing to be in the biggest city in the country. It’s another thing to be in a small town that may only have one pharmacy. Like, is this being distributed fairly?
Carly Weeks
That’s an excellent question. And one thing that’s I guess notable is that when some of the supply started coming into Canada, it was at first headed for hospitals. And a lot of people were really upset by that, saying parents need these medications for their kids at home to help them avoid the hospital. But I think on the other hand, you could see that kids who are in the hospital and hospitals across the country needed to have that supply. On that side of things, it sounds as though it was equitable from a distribution point. But I think, again, if you’re living in a smaller, rural, remote area, chances are it is going to be much more difficult for you to find that medication because there’s fewer stores, there’s going to be a lot of demand, and there’s not a whole lot of choice. So if you can’t get make it to the rectall near your office, you can go down the street and find five other pharmacies. Exactly. And then you think about even the people who are living in big cities like Toronto, who have mobility issues, who are struggling, who are working all the time, who can’t even necessarily afford these medications.
Jordan
We can’t spend an afternoon trekking across the city to find these things.
Carly Weeks
Exactly.
Jordan
Do we know about the final timeline for this? Or even if there is a final timeline now that it is back in some pharmacies? And again, in those pharmacies, there are signs up saying we’re limiting the purchase to one or two at a time. Is this stuff at some point going to be widely available again? And do we have any idea when that might be?
Carly Weeks
You know, the expectation is that, yes, it will be widely available at some point, but the timeline, I think, is impossible to predict. If you look to we were sourcing medication from the United States, and there are now widespread shortages all over the US. Of fever medications for kids. So from that standpoint, I think there’s going to be a lot more unpredictability in the coming months. Again, not to say people should be hoarding these things. You could buy a bottle or two of this medication and be set for a year, but with these ongoing supply chain issues, I don’t think that’s going to satisfy enough people. People will continue to go out and there’s going to continue to be that mentality of scarcity and fear of not being able to supply medicine for your child. Now it’s being exacerbated by what’s going on elsewhere. It’s hard to predict when this will all get resolved, and then it will be the next thing not to be a total pessimist, but then there’s going to be another shortage, another major issue. I mean, there’s a whole range of tier three shortages in Canada right now for drugs. Tier three are drug shortages that can actually sort of impact the ability of medical professionals to treat illnesses. There’s not much else they can use.
Jordan
If these medications are in shortage, there’s a number of them that have been going on for months, so these problems are not going away. Can you just give me a couple of examples of those? Because it’s funny that we’ve heard this, but not about that.
Carly Weeks
Yes, and I think that that’s because a lot of these medications tend to be a little bit more specialized or for things that we don’t necessarily think about. For instance, one of the shortages was for Amoxicillin for kids. So one of the antibiotics used in kids, I was told that it wasn’t a complete panic inducing moment because there was still a supply for adults, and pharmacists could easily make a solution for kids. But at the same time, in recent months, there’s been everything from epidural shortages to tube shortages, for collecting blood samples, to medications that are used in routine procedures.
Jordan
It’s a little bit scary when you do start to dive into this world and realize we have very little control over what medications are in stock, is the behaviour that we are seeing now, now that it’s starting to come back? You mentioned people will always have that feeling of scarcity. Does that prolong the problem here? Because now that it is back in stock, I mean, I bought the maximum two that I could. If I could have bought more Carly, I probably would have.
Carly Weeks
Yeah, I think that that’s just human nature. It was like toilet paper at the beginning of the pandemic. Exactly. From then I can’t remember what the next one? There was all of these really weird shortages of certain items, and there are legitimate shortages that are then exacerbated by that mentality of scarcity. So I need to get some because what if it’s not available ever again? And so I do think that reporting on this and the more we talk about it, it makes it worse. But at the same time, these are real problems that need solutions. Not talking about them isn’t going to make them go away. And certainly you worry about what is going to be the next thing and how do we guard against that? We were mentioning earlier that it’s difficult to find fever, cold, pain medication for adults. That’s something that will again, probably continue to ramp up and get worse before it gets better. So it is a little bit puzzling, it’s a little bit of a struggle, and it’s a little bit scary too.
Jordan
I was going to end by asking you, what can we do to prevent this? But you already kind of covered that. So I’ll just end by asking you, because this is something I’ve wondered about a lot since this shortage began and the shortage of other stuff. Are we gaining a new understanding for what pharmacists can actually do?
Carly Weeks
I think that’s an excellent point. And I think yes, I think that pharmacists are some of the unsung heroes in our healthcare profession where they are able to do a lot. They have many tricks up their sleeves, compounding medications, finding alternatives, cobbling things together. And not every pharmacy can do this. There’s special ones. And I think that we need to hold tight onto those compounding pharmacies, the few ones that are out there still, because they can do a lot of magic that can really get us out of jams like these.
Jordan
Carly, thank you so much for this. And only buy one or two of these things when you see them.
Carly Weeks
Everyone, please, please.
Jordan
Carly Weeks of the Globe and Mail. That was the big story. For more from us, head to The Big Storypodcast CA you can find us on Twitter at the big Story. FPN you can tell us, by the way, if your area has this medication back in stock yet. It’s funny. I mentioned to Carly the one downtown was full, the one right up the street from me. The drugstore that I’d normally use still totally empty, so who knows? And good luck. You can write to us hello at the Big Story podcast. CA and you can call us. Leave a message 416-935-5935 this podcast is available in your favourite player. If you haven’t yet, you got to remember to rate and review. That’s what drives us up the ranks. That’s what lets new listeners find our show, and new listeners are how we keep going. Thank you for listening. I’m Jordan Heath Rawlings. We’ll talk tomorrow.
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