I recently saw an article on the Canadian news site cbc.ca. It warned that there was a manufacturer’s shortage of the antidepressant bupropion, both brand name and generic. No reason was given for the shortage, and Health Canada doesn’t require this information. The brand name manufacturer told CBC that the shortage had been resolved and the medication would be appearing in pharmacies “imminently”. Earlier this year, there was a Canadian shortage of Epi-Pens, the life-saving medication to treat anaphylaxis.
Canada is certainly not the only country to have drug shortages. The blog Vision of the Night has mentioned shortages of the antidepressant clomipramine in the UK. A 2017 article in The Lancet said that the antipsychotic haloperidol was one of the most commonly shorted medications in South Africa. A 2017 study in the Saudi Pharmaceutical Journal found that over half of the community pharmacies surveyed had shortages of psychiatric medications including amitriptyline, aripiprazole, bupropion, buspirone, duloxetine, haloperidol, and lithium.
Unlike Health Canada, the Food and Drug Administration (FDA) in the United States requires that manufacturers report the reasons for drug shortages. 2017 statistics from the FDA show that the reasons given were manufacturing (30%), supply/demand (8%), natural disaster (3%), raw material (2%), discontinuation (2%), and the most common reason unknown (53%). It seems rather unlikely that more than half the time someone suddenly woke up at the factory and realized they’d stopped producing pills, and called the Ghostbusters to come investigate.
Sarcasm aside, it doesn’t seem as though the pharmaceutical industry is very motivated to address this issue. Presumably there is a business case for this, although at first glance it would seem that the best way to make money is to actually sell the product. While I’m not strongly anti-Pharma overall, the frequency at which drug shortages are occurring has a rather unpleasant smell to it.
Drug shortages impact health conditions across the spectrum, but I think the potential impact of psychiatric medication shortages is quite high. Medications are often grouped into classes based on their mechanism of action, such as selective serotonin reuptake inhibitors (SSRIs). For some classes of medication, a person can switch between drugs in the same class without much difficulty. It’s not that simple with psychiatric meds. Someone might respond well to one SSRI, but have poor effect and considerable side effects with another. For some psychiatric medications, like bupropion, mirtazapine, and lithium, there are no other medications that have exactly the same mechanism of action.
Aside from hoping that our meds won’t be shorted, there’s not a lot we can do. If you hear about a shortage, coverage issues can make it hard to follow the example of Elaine on Seinfeld in her quest to buy up every remaining Today sponge from every pharmacy in the area. I don’t know what the answer, but I think our national health regulators need to lean on Big Pharma a little harder than they’re doing right now.
Have you ever experienced a shortage of your medication? How did you manage?