Hey there, time traveller!
This article was published 20/4/2020 (522 days ago), so information in it may no longer be current.
Life is not normal for anyone right now, and that is very true for those who toil behind the counter in the pharmacy world. Aside from overall concerns about contracting COVID-19, there are many concerns for our profession.
We don’t receive personal protective equipment of any kind, nor even preferred access to such equipment. Thus, we are left to fend for ourselves in the retail market, which is still quite backlogged. Whatever PPE we get, it is a battle to constantly acquire more as there is no clue as to when the COVID-19 concerns will let up.
There are also many changes in how we have to operate. The 30-day limit on prescription refills was implemented by governments at the recommendation of the Canadian Pharmacists Association, for good reason: out of concern about possible stockpiling of medications — something akin to the much more familiar hoarding of toilet paper that has occurred during the pandemic.
The obvious consequence is increased dispensing fees for the public, and also increased visits to the pharmacy. As a pharmacist, I didn’t ask for this, and I for one would rather see fewer people these days so as to reduce my risk of getting COVID-19.
But governments are correct. Their reason for this restriction is, and has been, our reality for a few years: drug shortages. Some dispute that these shortages exist, but I can assure you this problem does exist and has existed for some time now. As governments always strive to maximize our health-care dollars, the push to lower generic drug prices over the past few years has led to numerous drug shortages.
Part of the problem is in always seeking the cheapest manufacturer; eventually, the only way these drug manufacturers are able to undercut North American drug companies is by cutting corners and using cheap labour. When such a factory is finally inspected, it sometimes comes to light that it has been using non-approved ingredients, some of which might even be carcinogenic, as happened with telmisartan, losartan, and metformin as recent examples.
So that supply chain dries up, until another generic manufacturer can produce a slightly better product.
It is no surprise that these manufacturers that either produce the active ingredient or the entire medication are mostly in India or China. Guess which country had all its manufacturing come to a halt first? China. There goes the supply chain. India followed soon after.
The end result on our continent is halted supply chains for pharmaceuticals. Toss into the mix the fact the largest wholesaler, McKesson, also owns its own pharmacies — Rexall — and that the competition bureau in Ottawa felt this was still fair competition, and the end result is rationing and unexplained shortages for some pharmacies and pharmacy chains, but not others.
So in the COVID-19 world, we now have to deal with these shortages by contacting doctors to prescribe alternatives. Like many other workers, doctors are spending much of their time dealing with daily changes and personal-security issues, adapting to virtual consults and other procedural obstacles. As a result, they’re not as easy to reach.
When we contact them to change to drug B because drug A is in short supply, by the time they reply, drug B might now be unavailable and maybe a drug C is available. Things change that fast.
If drug C isn’t available (or if it’s not appropriate for a particular patient), a new drug class must be considered, which involves the doctor taking more time to make the best choice. A good example is Ventolin, a common bronchodilator for asthma. There are few, if any, good alternatives, and we have waiting lists of patients wanting two, three or six such inhalers to have on hand, just in case. Is this hoarding? I’ll leave that for you to judge.
So now we have to spend not only the aforementioned extra time, but also new time cleaning and disinfecting, ensuring physical distancing within our locations, acquiring shields and using our very limited PPE as effectively as possible. At the end of the day, we go home, spending extra time washing up, being careful and hoping we aren’t infecting our families as a consequence of our work.
These are some of our burdens. The public’s is to temporarily endure more frequent dispensing fees.
Let’s all do our part by following the recommendations of public-health officials. But let’s also cut each other some slack. These are not normal times.
Willson Caetano is a graduate of the University of Manitoba’s faculty of pharmacy and a practising pharmacist for the past 23 years.