[IliketoPuck]

Originally Posted by Street Pharmacist

As with most things, it's made overseas. It's not as simple as just make more because it's a global issue and no one sees it coming. This is happening for lots of drugs. Right now it's happening for and amoxicillin suspension as well which really sucks. Need a steroid drop for an inflammatory eye disease for post cataract surgery treatment? Sorry, we got none. Do you take the enteric coated version of a particular anti arthritis med? Sorry, not available. Polysporin eye drops? Sorry, you'll need to see a doctor to get a prescription because they've been shorted for months. There are hundreds of drug shortages at any time and this just happens to be more visible. Heck, there was a shortage on an antiarrhythmic drug that had no substitute! It's a massive problem which takes up about an extra hour a day of my time apologizing and trying to find solutions.




Here's a big reason why told as an imaginary scenario (I'm sure there's lots of other issues in missing too):
Say there's 10 vendors making children's acetaminophen and 4 of them serve Canada. You may see 20 different brands but they probably all buy from those 4 vendors and package with their brand.

You're a vendor that sells to Canada as well as other countries. Due to a flood, COVID shut down in China, labour disruption, fire, etc, one of the suppliers for a chemical input has delayed supplying you for much longer than the same delays you're used to. Well, no one runs with spare capacity and partial batches are not possible or too expensive so you hold off making any until enough precursor is available. You sign a purchase agreement with another supplier whose current supply is exhausted and sold to other manufacturers and inform your customers when you think you'll have some more for them.

Now you're a wholesaler and when you make a few buys from your usual suppliers you get a delivery date much later than the usual delays (there's always delays). No big deal, you sell other brands and your customers can buy those and your warehouses and distribution networks still have some so it'll slowly drain out and hopefully you've got some in time before shelves of those few brands are empty, but others still seem to be in supply. The hidden issue here is, of the vendors who's supply is still fine, they have no spare capacity because no one builds a factory for a low margin item that isn't running at 100%.


Now you're the retailer and you carry the National brand and your own brand. You place orders all the time and there's shortages of one or the other all the time but they're always just a week or two. That's fine because you sell two brands and the customers can always buy the brand name if your corporate brand isn't available or vice versa. You order for acetaminophen suspension of one of the brands you carry isn't coming and now you're getting a shortage notice on your invoice. You look and find another brand to order and it comes in. Now demand goes through the roof, so you bump up your orders. Pretty soon there's delays in supply and your shelves are empty intermittently. Then you get the inevitable shortage notices on the ones you've been getting to replace the others.



There's a lot more to it of course, but you can see in this scenario it's complicated and there's a ton of different players involved. This has been happening with important medications for years and it's worsening. The federal government has tried addressing it with mandatory shortage reporting but that's fraught with problems as it's not black and white what constitutes a shortage. Then there's the fact that simply knowing there's a shortage a few days before not being able to get it really doesn't actually help. I don't think over the counter meds qualify anyways so it's probably for this shortage.

That's a long way to say I don't know how to fix this but it needs to be addressed. The US supply isn't really fine, but as a giant market they have enough vendors to plug the holes of the ones missing and their suppliers are big buyers that get their shipments fulfilled first.

I literally ran into the eye drop thing this morning. What the fata. Could always just get it over the counter. But now I have to find a bloody walk-in doctor to write a prescription so I can get something mixed up by the pharmacy.

Fata.