Children’s painkiller shortage is crowding the ER, but there are solutions, doctors say

Children’s painkiller shortage is crowding the ER, but there are solutions, doctors say

After months of watching her young children suffer from fever after fever, with limited access to painkillers and fever-reducing medications, it became almost unbearable, says Washim Ahmed.

β€œIt is absolutely devastating to see that your son is in pain and that you are completely helpless,” said Pickering, Ontario, father of two.

With cold and flu season in full swing across the country, and new strains of COVID emerging around the world, many parents share Ahmed’s frustration that pediatric pain and fever medications containing acetaminophen and ibuprofen they have become even scarcer after a period of six months. Scarcity across Canada.

A combination of factors has created the shortages, according to information from epidemiologists, emergency room doctors and Health Canada officials: A lack of raw materials to make the drugs has been combined with a surge in respiratory viruses fueled by the relaxed measures. of COVID. And panic buying is running out of stock 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 pain relievers typically found on drugstore shelves.

Ahmed gives his son Barraz Wahaj Ahmed medicine he picked up at a Detroit pharmacy. He is pictured here with his wife Bushra Mahdi in their Pickering, Ontario. 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 stock up on medication while in the US.

“We had at least six hospital visits this year with my children,” said Ahmed, who said it got worse after his three-year-old son went to preschool and brought home infections.

So while in Detroit, Ahmed loaded up on children’s pain relievers at a well-stocked pharmacy, and brought more home for other families. When he offered to share the medicine with other desperate parents, he said one person drove more than an hour from Oakville, Ontario. – to get a bottle.

Canada has faced a six-month shortage of children’s medicines and the raw material to make them, even though shelves are full in the US. Some pharmacies are now keeping products behind the counter and limit purchases. (Yvette Brend/CBC News)

some hope

The shortage means preventative measures like flu and COVID shots, mask wearing and handwashing are critical, doctors say. But Dr. Anna Banerji, a specialist in childhood infectious respiratory diseases and director of Global and Indigenous Health at the University of Toronto, said she understands the shortage is creating anxiety for parents.

I think this is going to be a difficult respiratory season,” he said. “We still have COVID and we’ve removed public health measures, and you have these mostly unvaccinated kids in school.”

But he said he is hopeful the shortage will be short-lived.

“This is a pretty basic drug; we could have tried it in other countries.”

Meanwhile, Banerji said parents who take their children to the emergency department for pain and fever medication are putting additional pressure on Ontario’s already overcrowded emergency rooms, further increasing turnaround times. wait.

She and other health officials are urging parents to find alternatives to going to the ER: giving a child adult fractional doses or asking a local pharmacist to create a compounded liquid form of the painkiller.

Be precise with doses, says pharmacist

Banerji said people should avoid using expired medications and be careful when giving divided doses. When it comes to ibuprofen, the limit that a child older than six months can have is 10 milligrams per one kilogram, which means that a 20-kilogram child can receive a 200-milligram adult dose of crushed ibuprofen.

With paracetamol, a child older than six months can take 10-15 milligrams per kilogram.

“If you give too much, you can have problems with the child, especially with the liver,” Banerji said. “And you should know that you can’t give a child with a fever aspirin because they can have a serious reaction, a serious complication.”

There are alternatives to provide relief for children with colds and flus, either a compounded medication from a pharmacist or a divided dose. (George Rudy/Shutterstock)

Going to a pharmacist is another option, as long as you have the ingredients and the ability to combine medications. The option is not a long-term panacea for scarcity; they are already juggling flu and COVID vaccines and only offering compounds in certain locations, said Danielle Paes, chief pharmaceutical officer at the Canadian Pharmacists Association.

“That’s something you’ll need to talk to your local pharmacist or pharmacy to find out what’s available there,” he said of the compounding service. “It’s not as commonly available. Unfortunately, you can’t just walk into any pharmacy and have that service available.”

Find a faster solution

In Ottawa, pharmacist Lubna Fawaz said a lack of raw materials to make children’s fever-reducing drugs has caused shortages at her store since early spring 2022. She tried to offer alternatives, from suppositories to compounds.

She is urging the Canadian government to find a quick fix, including encouraging more pharmaceutical manufacturing here.

“It’s really hard, especially seeing my kids coming out of hospitals, being discharged and needing Tylenol,” said Fawaz, who keeps checking his computer for more supply opportunities.

“If I don’t have any solution, it would be a disaster.”

On November 3, opposition leader Pierre Poilievre issued a statement criticizing the government for failing to address the shortage.

“Desperate moms and dads now have to choose between taking their sick children to overcrowded emergency rooms or crossing the border into the United States, where there is no shortage of these basic medicines. American shelves are full. Canadian shelves are full.” empty”, Poilievre. she said in her statement.

Ottawa pharmacist Lubna Fawaz says a shortage of ingredients for children’s painkillers has continued since the spring. (Marina Von Stackelberg/CBC)

Is labeling slowing down the solution?

Health Canada says it recently began allowing ibuprofen from the United States specifically for hospital use and will soon 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 reviewing proposals from certain companies, Sharma said manufacturers must show “that it is the same or very similar to the product we have.” [and that it’s] manufactured under appropriate conditions.

The regulations also require product labeling to be bilingual, something Banerji suggested could be partially waived given the urgency of the situation.

It’s important to get this “vital” medication that “prevents a lot of suffering in children and a lot of anxiety in parents,” he said. “If the approval process to translate it into French is quick, 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 brochure or flyer at the counter.

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