Local pharmacists getting creative during children’s medication shortage

WELLINGTON COUNTY – Local pharmacists are getting creative to address a national supply shortage of child-dose painkillers and anti-inflammatory medication.

“We are fully out of commercially-available liquid acetaminophen or ibuprofen,” said Bronwyn Tolmie, co-owner and pharmacist at Pharmasave Trailside Pharmacy in Fergus.

Chewable forms are also out-of-stock and backordered.

“You name it, I’m short of it,” said Ravi Halani, pharmacist and owner of Pharmasave Mount Forest Pharmacy.

“It’s totally real, and it’s totally a problem,” said pharmacist Rachel Luther, who owns Centre Wellington Remedy’s Rx in Fergus.

In response to the frenzied buying and short supply, local pharmacists are limiting how many bottles can be purchased at a time and keeping what would normally be a readily accessible product behind counters.

“Part of it is panic-buying,” Luther said.

She and other pharmacists the Advertiser spoke to pointed to an Aug. 15 letter from Toronto’s SickKids Hospital, addressed to parents and caregivers, stating that because of shortages of common child-dose fever and pain medications, especially in liquid form, prescriptions would be required.

A day later, SickKids offered clarity, stating, in part, “The letter was not intended as a recommendation for the general public.”

“For sure it triggered panic-buying, and it’s been a problem ever since,” Luther said.

Halani said the supply problem was “blown out of proportion” after the letter was circulated.

The other reason for shortages, the pharmacists all agree, is a bona fide demand for medications because of seasonal flu and colds.

“One hundred per cent there’s a lot of kids who are sick right now,” Luther said, referencing the many prescriptions being filling for antibiotics and inhalers.

As both real and perceived demand shot up around September, shelves began emptying and the shipments of child-dose medications became more sporadic.

“Sometimes we’re honestly learning about these things around the same time the media does,” said Tolmie, adding they were “caught off guard” when shelves began emptying in September.

The pharmacists say they are fielding multiple calls and inquiries every day about child-dose medications.

McKesson Pharmaceutical Distribution supplies most independent retail pharmacies here.

The company has 12 distribution centres in Canada and supplies 7,100 pharmacies and 1,350 hospitals across the country, according to its website.

“On our ordering system, it will just show that the item is no longer available for us and we just notice that it’s not coming in our orders,” Tolmie said.

Luckily, Tolmie has had “just enough on hand” to sell to those who need it.

At Centre Wellington Remedy’s Rx, Luther says they don’t have an issue with tablets.

“But we do have a problem with the supply of liquids,” she said.

“Even with the junior chewable tablets for acetaminophen and ibuprofen—we have no supply.”

Halani gets an alert from McKesson when stock is available, but he’s in competition with thousands of other pharmacies for the same limited supply.

“By the time an order is placed, it’s luck, because everyone is doing the same thing,” he said.

In a statement provided to the Advertiser, McKessen stated, “the ongoing shortage of children’s acetaminophen and ibuprofen formulations as well as cold and cough medicine is the result of a combination of high summer demand and shortage of raw materials at the manufacturer level.”

The statement notes the shortage “is expected to persist throughout the fall with COVID-19 and flu further fuelling demand.”

McKessen did not respond to a direct request for comment from the Advertiser on Nov. 18.

Foreign supply coming next week

During a Friday news conference, federal health officials spoke to the shortage and what the government is doing to procure foreign supply.

Health Canada chief medical advisor Dr. Supriya Sharma said “foreign product” is entering Canada to supplement domestic supply.

“After next week, more than one million bottles of product will have entered Canada to supply hospitals, community pharmacies and retailers,” Sharma said.

“Medications will start appearing on store shelves starting early next week.”

Imported products, she said, will include liquid forms of acetaminophen and ibuprofen for children and infants of the “same high quality safety and efficacy as what we have in the country.”

“The situation is very challenging for parents and caregivers, as well as our healthcare system,” Sharma said, adding the federal government is working to end the shortages by looking for additional suppliers.

“It’ll take time, but things will get better as we start to see the results of increased production of Canadian acetaminophen and ibuprofen products supplemented by the flow of foreign products.”

Crushing, cutting, compounding

Local pharmacists are getting around bare shelves by offering families and caregivers alternative solutions.

Adult-sized doses can be halved, quartered, or crushed into appropriate child-sized doses, which vary with weight and age.

“If somebody has a sick child at home, we can often find an adult product and then make sure that it’s the right dose for the child to take by cutting the tablets and then crushing them at home and putting them in something at home,” Luther said.

In Mount Forest, Halani says if a parent or caregiver isn’t confident about the dosing, he’ll prepare child-sized doses from adult tablets.

And at Trailside Pharmacy, they’re able to take adult tablets and compound them into a liquid format.

“We can essentially take an adult format of medication and create or compound it into a liquid and it would be similar to what is commercially available,” Tolmie explained.

Compound products, essentially made from scratch within the pharmacy, don’t have the same shelf life as a commercially-made product and are only good for 14 days, but the active medicinal ingredient and its effectiveness is equal.

“We are well-versed and know how to troubleshoot or look for alternative options,” Tolmie said.

“It’s not an uncommon thing for a medication to go on backorder,” she added.

“It’s just this is such a commonly used medication, so it’s so in the forefront and it’s happening at such a time where there is need, so it’s more in the public light.”