Drug shortages: What, why, and how (Part 2 of 2)

HN Summary

• Drug shortages can compromise patient safety and access to treatment. Prolonged shortages can exhaust reserve supplies and alternatives, while switching medications may introduce dosing errors, adverse effects and higher costs, particularly when substitutes lack insurance coverage. 

• Multiple supply pressures leave Canada vulnerable. Manufacturing problems, recalls, increased demand and shipping disruptions can trigger shortages. Canada’s small share of the global pharmaceutical market and reliance on imported drugs add to these challenges.

• Proactive coordination can help protect continuity of care. Governments, manufacturers, distributors and healthcare teams all have roles in managing shortages. Designated monitoring staff, standardized substitution protocols, shared supply information and clear patient education can reduce disruption and support safer care.

What is a drug shortage?

A drug shortage occurs when there is not enough supply to meet its demand. In recent years, drug shortages have become a growing global public health concern, affecting patient care, healthcare providers, and the health care system. The impact of each drug shortage will vary based on factors, such as duration of the shortage, available alternatives or substitutions, and associated cost implications, etc.

In Canada, drug shortages last an average of several months. Extended duration of drug shortages could heighten the potential for patient harm as reserve stocks deplete, along with available therapeutic alternatives. Patients faced without a suitable alternative are disproportionately impacted compared to those with other therapeutic options. Despite the availability of alternatives, medication safety risks may still exist. Switching products, particularly when patients are not familiar with the alternative, and returning to the original product after the shortage is resolved, may pose risks or potential drug therapy problems, such as ineffective or duplicate therapies, dosing errors, or adverse drug events. Alternative options may also impose additional costs to patients and the healthcare system. Patients or institutions could face higher out-of-pocket costs if the available therapeutic alternative is not covered by the patients’ insurance plans or not listed in the hospital formulary, respectively. Consequently, drug shortages may exacerbate socioeconomic barriers for patients to access their medication(s).

Why do drug shortages occur?

Drug shortages can be caused by many reasons, for example, manufacturing or quality issues, unexpected increases in demand, reductions in supply, or fluctuations in both supply and demand, safety issues resulting in drug recalls, shipping delays or distribution problems, or drug discontinuation, etc.

Canada takes up about 2% of the global drug sales, a relatively small market of which most of the drugs are imported and likely sourced from a single supplier. This has led to Canada being prone to drug shortages. Readers can learn more about health product shortages in Canada by viewing a Government of Canada resource: “Building resilience: Health Canada’s plan to address health product shortages, 2024 to 2028” 

How to address and/or prevent drug shortages?

While Health Canada plays a key role in responding to drug shortages (e.g., by leveraging regulatory tools to allow more supplies, such as, importing foreign-authorized drugs), many other interested parties or stakeholders also help address and/or prevent drug shortages. They include:

• Provinces and territories – communicate and collaborate with hospitals, pharmacists, retailers, and distributors to manage supply of drugs;

• Manufacturers – mandatory reporting of anticipated and actual drug shortages and discontinuations of drugs to Health Canada. Increase production of drugs or expedite resupplies;

• Importers and distributors – manage and monitor inventory of drugs and expedite delivery of resupplies;

• Healthcare providers and patients – Readers can refer to the October 2026 issue – “Drug Shortages: How Pharmacists Can Help” where we shared what pharmacists and patients could do during drug shortages to support safe, equitable, and continuous care.

Steps Forward

Drug shortages can interrupt or disrupt workflow for pharmacists and other healthcare workers significantly and unexpectedly. Assigning designated individuals or personnels to monitor for drug shortages, developing standardized substitution protocols, triaging usage, sharing knowledge and supply information among institutions, providing education and actionable steps when drug shortage does occur can alleviate workplace stress and promote seamless continuity of safe and effective patient care.

By working proactively, establishing reporting and response protocol, and improving communication and transparency throughout the drug supply chain, the negative impacts of drug shortages could be mitigated. The Health Canada Infographic: Helping Canadians deal with drug shortages highlights valuable tips that everyone can help with drug shortages.

Olivia Mendicino and Taylor Monrad are PharmD students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor, Teaching Stream, at the Leslie Dan Faculty of Pharmacy and Department of Psychiatry, University of Toronto.

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