COVID-19 exposes drug supply gaps as ‘made in Canada’ solution proposed

TORONTO — For more than a decade, Canada has had a supply shortage of essential medication, an issue now exacerbated by COVID-19, but a “made in Canada” solution is being proposed that could potentially help resolve this long-standing problem.

“What keeps me up at night is the potential that we are going to run out of some of these crucial medications,” said Christina Adams, the chief pharmacy officer for the Canadian Society of Hospital Pharmacists.

“Because drugs are not produced here in Canada, we’re at the mercy of the market when it comes to trying to acquire additional supply in times of need.”

Worries about shortages have some scientists and health experts eyeing “out of the box thinking” that could help Canada reduce its reliance on foreign supplies of critical medication.

China and India supply some 80 per cent of the active ingredients and raw materials for many of the medications, and while some drugs are assembled in Canada, none are completely manufactured here from start to finish. With huge demands worldwide and few sources, some are now proposing that essential drugs be made in Canada – using state-of-the-art technology.

Andre Charette, an organic chemist and head of University of Montreal’s chemistry department, believes Canada has the technology and expertise to produce its own raw materials on demand and make enough of its own prescription drugs.

This could be done using a special technique called “continuous-flow molecular synthesis,” which makes synthesizing organic molecules easier and more efficient. It is a process that the University of Montreal has developed particular expertise in over the last decade, along with researchers from around the world including the Massachusetts Institute of Technology and the University of Cambridge.

The method is a new way of making drugs that Charette believes could work. The first trial at the university’s continuous-flow synthesis lab is to make a test batch of the key compound found in a drug that is essential for critically ill COVID patients: the sedative propofol.

Traditional methods for making that ingredient require enormous facilities producing them in large quantities – hundreds of kilograms of molecules – at once. The continuous-flow process, however, means they can be made in a compact machine no larger than a refrigerator in smaller, but continuous quantities.

“I’m quite confident that we would add a route, a procedure or a recipe to make propofol in a matter of weeks since it’s a very simple molecule,” said Charette.

SHORTAGE ALERTS AND PRESCRIPTION LIMITS LIFTED

Adams says there is a real sense of urgency now to ensure there is an uninterrupted supply of medications in the Canadian market. It is “unthinkable” she says, to run out of medication like propofol, due to its vital importance in managing patients on ventilators, or anyone requiring surgery or anesthesia for any reason.

Emergency room physician and York University professor Dr. Joel Lexchin said Canada should be making a list of essential drugs that could face shortages because only one or two companies manufacture them and figuring out how to mitigate the risk of a supply crunch.

“We should have woken up a long time ago around the issue of drug shortages,” said Lexchin.

“It’s cheaper to produce things in China or India than it is in North America. So we need to recognize that we don’t want to make drugs a lot more expensive. But on the other hand, if they’re not available at all, we can be in serious trouble.”

With prescription drugs for epilepsy, high blood pressure, painkillers, asthma inhalers among the critical drugs on an ever growing shortage list, many pharmacies across the country have been limiting patients to one month’s worth of medication at a time to discourage people from stockpiling medication amid the uncertainties around the pandemic.

Doctors are also experimenting with different treatments using existing medications to help hospitalized COVID-19 patients, which in some cases, have led to misinformed members of the public stockpiling the medicine and causing shortages for patients suffering from other serious diseases requiring the drugs.

The supply shortage is a particular worry for hospital pharmacists.

In the last week and a half, Health Canada has issued multiple alerts to pharmacists, anesthesiologists and physicians to inform them that due to “unprecedented demand and shortage” of neuromuscular blocker products and paralyzing agents in Canada due to the COVID-19 pandemic, it is allowing the importation of several U.S.-labelled drugs that are not authorized for use in Canada or are of different concentration levels than what is marketed in Canada. And last month, the agency issued an alert on a shortage of salbutamol inhalers, also due to increased demand because of the pandemic.

Meanwhile, some provinces are already lifting pharmacy restrictions on dispensing prescription medication, pointing to a stabilizing drug supply and amid concerns and criticisms that patients are having to pay for more dispensing fees and co-payments. A typical 90-day prescription, for example, would need to be filled three times instead of once, multiplying fees that can be especially prohibitive for retired seniors and the many Canadians who are now unemployed.

The government of New Brunswick lifted its temporary measures late last month and Newfoundland and Labrador has also eliminated a similar cap.

In British Columbia, the province’s College of Pharmacists left it up to individual pharmacies to decide whether they would implement a 30-day limit or not, and several were already dispensing 90-day scripts around the end of April. Manitoba followed suit Friday, allowing prescriptions to be filled three months at a time if there was no shortage of that particular medication.

Back at the University of Montreal, Charette is looking for support to start testing, producing and potentially selling to generic drug makers. At the moment, production is limited to one or two active compounds, but Charette believes that could be easily increased.

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