Painkiller shortage: Pharmacists ‘are the bridge between the supply chain and patient care’

For the last couple of weeks, a national shortage of commonly prescribed painkillers has left pharmacists scrambling. The drugs in question—acetaminophen with oxycodone and acetaminophen with codeine—are typically prescribed for acute or chronic pain, and are often used for back and neck pain, sprains, dental extractions, kidney stones and headaches. Pharmacists are used to dealing with drug shortages—Sadaf Faisal, senior director of professional affairs at the Canadian Pharmacists Association (CPhA), says pharmacists spend up to 20% of their time managing shortages. But this shortage is much more complex, resulting in pharmacists spending even more time identifying alternatives, seeking out supply and, in some cases, limiting supply for their patients.Finding a substitute for these painkillers can be difficult because many of the alternatives are controlled substances, so pharmacists can't make changes to these prescriptions without a doctor's approval—adding friction and workload. And because many of the patients using these drugs use them on a long-term basis for chronic pain, Faisal says that substitution requires a “very individualized approach” to monitor for side effects and withdrawal symptoms. “For these particular medications, substitution can be challenging because pharmacists need to work with each patient to find the right fit,” Faisal explains, adding that sometimes patients will resist a substitution because of concerns surrounding side effects, tolerability and reduced effectiveness. Unlike medications for, say, blood pressure, where there are lots of available alternatives and where pharmacists have the ability to adapt a prescription, a shortage of these painkillers is creating a massive burden for both pharmacists and physicians across Canada. It’s why the CPhA wants to see a change in the Controlled Drugs and Substances Act (CDSA) that would allow pharmacists to adapt these prescriptions without waiting for a physician, to ensure there is a continuity of care, Faisal explains. Luckily, the shortage should be resolved by early August. But, until then, Faisal says that the CPhA has a resource online to help guide pharmacists during the shortages. The resource includes management options—for example, avoiding starting new patients on impacted drugs and encouraging patients to contact their pharmacy before running out. Faisal also says that the CPhA wants to hear from pharmacists on their experience with this shortage so that they can bring comments to Health Canada as they work to advocate for stronger support for pharmacy teams. “Any time a drug shortage hits, pharmacists step up,” Faisal says. “They are the bridge between the supply chain and patient care, and they work to find alternatives, collaborate with prescribers and keep patients informed every step of the way. Pharmacists are doing an awesome job supporting patients and doing so much more behind the scenes than people know.”

Painkiller shortage: Pharmacists ‘are the bridge between the supply chain and patient care’

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