Shortage of drugs worrying anesthesiologists; 2 hospitals nixed heart surgery
TORONTO - The drug shortage gripping Canada has anesthesiologists across the country worried they won't have enough drugs to perform surgery or the sedatives and painkillers needed to keep patients comfortable before and after their procedures.
"I've been getting a lot of emails from colleagues right across the country," said Dr. Rick Chisholm, president of the Canadian Anesthesiologists' Society.
"What I've heard from the rest of the country is (hospitals are) sort of taking stock of what inventory they have, what their typical usage is, trying to figure out how long their stocks are going to last, looking up what supplies Sandoz has told them they're going to be able to ship."
Sandoz Canada is at the centre of an escalating drug shortage, resulting from the company cutting production of more than 100 medications after the U.S. Food and Drug Administration raised concerns about quality standards at the company's Boucherville, Que., plant.
A fire on March 4 also affected the plant, which makes 90 per cent of injectable medications used in Canada, among them anesthetics, painkillers, cancer drugs and antibiotics.
Chisholm, an anesthesiologist at the Chalmers Regional Hospital in Fredericton, said he's been contacted by colleagues elsewhere in Canada who say they are looking for alternatives for medications that are running short, even turning to old-style anesthetics that haven't been used for years.
"I've seen planning where they're talking about when they get down to a week of essential drugs that they have left, they're going to have to start looking at possibly curtailing some elective surgery," he said.
Such a cancellation occurred Tuesday when two Vancouver hospitals postponed elective heart surgeries for nine patients over fears the dwindling stock of a critical medication would leave doctors without enough to deal with emergency cardiac cases.
The drug protamine is the only drug anesthesiologists have to reverse the effects of the blood-thinner heparin, which is given during heart bypass surgery. Sandoz is one of only two companies that makes the medication and the primary supplier to Canadian hospitals.
As it turned out, it wasn't necessary for St. Paul's and the Vancouver General hospitals to cancel the surgeries, said Gavin Wilson, a spokesman for Vancouver Coastal Health.
"They weren't cancelled due to a shortage of drugs. They were cancelled because of some miscommunication and a failure to follow the process that we've established here to deal with the Sandoz situation," Wilson said Wednesday from Vancouver.
The joint cardiac surgery program for the two hospitals decided to put off the scheduled operations after being told there were only about two weeks' worth of protamine left in stock.
"In fact, we have several weeks' supply of protamine available, so the surgeries that were cancelled, we're trying to reschedule them as quickly as possible, and some are already rescheduled," he said. "Aside from yesterday's misunderstanding, we haven't had any impact on patient care."
Asked about the issue Wednesday in the Commons, Prime Minister Stephen Harper acknowledged the drug shortage poses some difficult problems, but he said his government is looking for solutions.
"The provinces are responsible for purchasing their drugs," Harper said. "In this case, they purchased the drugs on a sole-source basis, and that source has come under stress ... we are working with them trying to address this problem."
In Ontario, the provincial health minister has a five-point plan aimed at helping hospitals to address drug shortfalls that could affect patients.
Anthony Dale, vice-president of policy and public affairs at the Ontario Hospital Association, said he's not aware of surgery cancellations at any of the province's 150 hospitals, but the Cardiac Care Network has voiced concern about shrinking stocks of protamine for heart operations.
"It's central to all cardiac surgery in the province," Dale said. "It is not yet in shortage, but they are carefully managing supply. And I think protamine is at the top of the government's priority list when it comes to dealing with Ontario's circumstance."
Like his fellow anesthesiologists, Chisholm is concerned about supply gaps for other medications, specifically pre-surgical sedatives to reduce anxiety in patients and post-operative narcotics to alleviate their pain.
"I can swap them around, but I'm limited because Sandoz makes most of them," he said. "I think they make fentanyl, they make morphine." Both are on the list of Sandoz products in short supply.
Dale said Sandoz produces many different forms of morphine and the reduction in stock is also alarming for hospitals.
"I think people believe that could be another area of more immediate concern," he said, noting that the province is tabulating information from hospitals on morphine supply and what Sandoz has told them about future production, as well as where generic substitutions might be obtained.
While Chisholm is confident he has anesthetics in his drug arsenal made by companies other than Sandoz, there are some medications he requires that only the Quebec plant provides, among them one for nausea and vomiting.
Some relief on that score came Wednesday, when Health Canada approved Aloxi, a drug to prevent severe stomach upset in adults that can occur from taking certain anti-cancer medicines.
The drug made by Eisai Ltd., a Canadian subsidiary of a Japanese company, was already in the regulatory pipeline and not one of the 15 products Health Canada is assessing over the next few weeks as part of a fast-track program to replace Sandoz medications in short supply.
Chisholm said there are other agents he uses to reverse the effects of drugs that are essential for some operations — such as muscle relaxants — which are also made by Sandoz.
"Everything I use is a sterile IV injectable. Everything I use is a generic IV injectable — and 85 per cent of the drugs in my cart are from Sandoz," he said.
"So if I don't have it, I've got to go look for something else."
Note to readers: This is a corrected story. An earlier version said Chisholm was president of the Canadian Anesthesiologists' Association.