“It’s absolutely devastating to see your child in pain and be completely helpless,” said the Pickering, Ont., father of two. With cold and flu season in full swing across the country and new variants of COVID emerging worldwide, many parents share Ahmed’s frustration that pediatric pain and fever medications containing acetaminophen and ibuprofen have become increasingly rare after six months Shortage across Canada. A combination of factors has created the shortage, according to information from epidemiologists, emergency room doctors and Health Canada officials: a shortage of raw ingredients to make the drugs has combined with an increase in respiratory viruses fueled by relaxed COVID measures. And panic buying is depleting the supply as soon as it arrives, pharmacists tell the CBC. The solution some parents turn to is the emergency room: a place where doctors say families spend hours waiting to be seen for colds and viruses so they can get pediatric painkillers usually found on pharmacy shelves. Ahmed gives his son Barraz Wahaj Ahmed medication he picked up from a Detroit pharmacy. He is pictured here with his wife Bushra Mahdi in their Pickering, Ont. Home. (Pelin Sidki/CBC News)
More hospital visits
In Ahmed’s case, his family saw an increase in hospital visits until he was able to obtain medication while in the U.S. “We’ve had at least six hospital visits this year with my kids,” said Ahmed, who said it got worse after his three-year-old went to preschool and brought infections home. So, while in Detroit, Ahmed loaded up on children’s painkillers at a well-stocked pharmacy, bringing extra home for other families. When she offered to share the medicine with other desperate parents, she said one person drove more than an hour — from Oakville, Ont. — to get a bottle. Canada has faced a six-month shortage of children’s drugs and the raw ingredient to make them, despite full shelves in the U.S. Some pharmacies are now keeping the products behind the counter and limiting purchases. (Yvette Brend/CBC News)
Some hope
The shortage means preventive measures such as flu and COVID vaccinations, masks and hand washing are critical, doctors say. But Dr. Anna Banerjee, an expert in infectious respiratory diseases in children and director of Global and Indigenous Health at the University of Toronto, said she understands the shortage is creating stress for parents.
I think this is going to be a difficult breathing period,” he said. “We still have COVID and we’ve lifted public health measures and you have these kids mostly vaccinated in school.”
But he said he hopes the shortage will be short-lived.
“This is quite a basic drug – we could have tried to source it in other countries.”
Meanwhile, Banerji said parents taking their children to emergency departments to get pain- and fever-reducing drugs are putting additional stress on Ontario’s already overcrowded ERs — and further increasing wait times.
She and other health officials urge parents to consider alternatives to going to the ER: giving a child fractional doses for adults or asking a local pharmacist to create a compounded liquid form of the pain reliever.
Be precise with the doses, says the pharmacist
Banerji said people should avoid using expired medicines and be careful in administering fractional doses. As for ibuprofen, the limit that a child over six months of age can have is 10 milligrams per kilogram, which means that a 20 kilogram child can take a dose of 200 milligrams of crushed adult ibuprofen. With acetaminophen, a child older than six months can get 10 to 15 milligrams per kilogram. “If you give too much, you can have problems with the child, especially with the liver,” Banerji said. “And you have to know that you can’t give aspirin to a child with a fever because they can have a serious reaction to it, a serious complication.” There are alternatives to providing relief to children with colds and flu, whether it’s a compounded medication from a pharmacist or a fractional dose. (George Rudy/Shutterstock) Turning to a pharmacist is another option, provided he has the ingredients and the ability to compound medicines. Choice is not a long-term panacea for scarcity. they’re already juggling flu and COVID vaccines and offering compounded substances only in certain locations, said Danielle Paes, chief pharmacist for the Canadian Pharmacists Association. “That’s something you’ll have to talk to your pharmacist or local pharmacy about to find out what’s available at that location,” he said of the compounding service. “It’s not that widely available. You can’t just walk into any pharmacy and have this service available, unfortunately.”
Find a faster solution
In Ottawa, pharmacist Lubna Fawaz said a lack of raw ingredients to make children’s fever medicine has led to shortages at her store since early spring 2022. She has tried to offer alternatives, from suppositories to compounds. He is urging the Canadian government to find a quick solution, including encouraging more pharmaceutical production here. “It’s really hard, especially seeing my kids come from the hospitals, being discharged and needing Tylenol,” said Fawaz, who continues to check her computer for more supply opportunities. “If I don’t have solutions, it would be a disaster.” Ottawa pharmacist Lubna Fawaz says the shortage of ingredients for children’s painkillers has continued since the spring. (Marina von Stackelberg/CBC)
Is marking slowdown a solution?
Health Canada says it recently began allowing the importation of ibuprofen from the United States specifically for hospital use and will soon also allow the supply of acetaminophen from Australia for hospital use as well. Imported drugs must meet Canadian health standards, says Health Canada’s chief medical adviser, Supriya Sharma. Although the regulator is considering proposals from some companies, Sharma said manufacturers must show “that it is the same or very similar to the product we have [and that it’s] is made under the right conditions”. Regulations also require product labeling to be bilingual, which Banerji suggested could potentially be waived in part because of the urgency of the situation. It’s important to get this “vital” drug that “prevents a lot of suffering for children and a lot of stress for parents,” he said. “If the approval process for downloading it in French is quick, then that’s fine.” But if it takes weeks, he said it’s time to consider alternatives, such as a link to a website for bilingual information or a flyer or brochure at the counter.
