British Columbia

'Frustrating' EpiPen shortage making allergy patients anxious

Some pharmacies in B.C. are running out of EpiPen injectors, leaving patients with life-threatening allergies searching for what's left after months of "frustrating" shortages.

Self-injection with syringe may be only option when supplies run out says B.C. Pharmacy Association

'It is causing some anxiety,' says Burnaby, B.C., mom Phuong Nguyen. (Nic Amaya/CBC)

Some pharmacies in B.C. are running out of EpiPen injectors, leaving patients struggling to find what's left after months of "frustrating" shortages for the auto-injector relied on by people with life-threatening allergies.

Since early 2018, Pfizer Canada has reported shortages due to "manufacturing delays," and Monday, Health Canada said no new stock would arrive until late August — meaning pharmacies could soon run out.

Burnaby, B.C., mother Phuong Nguyen says she called six pharmacies Monday, looking to replace an expiring EpiPen for her nine-year old daughter with a life-threatening peanut allergy.

The girl carries an EpiPen everywhere, because she can go into an anaphylactic reaction from merely touching peanuts.

But Nguyen's neighbourhood pharmacy was out.  She tried a Rexall, Costco, Safeway and two Pharmasaves in the area before finally finding one at Save-On.

Normally, Nguyen said she'd buy two — one as a backup — but that wasn't an option this time as pharmacies ration supplies.

"They only had two left, so the pharmacist would only give me one. Fair enough," said Nguyen, who felt lucky to get that.

"It is causing some anxiety ... I think I would have started panicking by mid-August if I couldn't secure one."

There is only one type of epinephrine auto-injector available in Canada, supplied by Pfizer Canada. (Jennifer Lee/CBC)

Supply 'sporadic ...dwindling'

Meanwhile, across the province, the B.C. Pharmacy Association calls the ongoing shortage "very frustrating," and is looking for alternatives but none are ideal.

"There is still some supply out there, although it is sporadic, and its definitely dwindling," said Linda Gutenberg, deputy CEO and director of pharmacy practice support.

In Vancouver, MacDonald's Prescriptions said its been ordering extra trying to keep some in stock.

In Fort St. John, pharmacist Mostafa Seleem said he has eight in stock that he's holding onto for people in dire need.

London Drugs, which has 80 stores across B.C., Alberta, Manitoba and Saskatchewan, still has EpiPens in stock and has been trying to manage demand — asking patients to just buy one.

"What people will do is, they'll put one everywhere they are," said pharmacy general manager Chris Chiew, noting some patients would have one for home, work, the gym, their car.

"We remind them this has been an ongoing shortage, and we want to make sure everybody is safe ... then we ask them to just buy one [and] carry that one around with them all the time."

London Drugs says it's hopeful stock will last until new supplies arrive in late August.

But even then, there's no guarantee the ongoing supply issues will be over, leaving customers like Nguyen frustrated too.

"This is a life saving medication. It's not a Tylenol you take for a headache."

London Drugs still has EpiPens in supply and is trying to manage demand, asking patients to buy one at a time rather than stockpile the devices, according to Chris Chiew, general manager of pharmacy. (Nic Amaya/CBC)

The alternative: a syringe

In Canada, there are no alternative auto-injectors, armed with a pre-measured dose of epinephrine, also known as adrenaline, that's easy to deliver in an emergency.

But the drug is not, itself, in short supply — leaving one possible option for someone who might need adrenaline in minutes, before getting medical treatment in hospital.

When EpiPens run out, patients could fill the prescription for adrenaline and learn to measure and inject it with a syringe, said Gutenberg of the B.C. Pharmacy Association.

"It's not ideal," she said.

"But at the point where there is no supply left, it will be the only strategy that people can utilize to have the medication available if it's needed."

Pharmacists are looking at teaching patients how to self-inject adrenaline using a syringe if EpiPens run out, but that's 'not ideal' during an anaphylactic reaction, said the B.C. Pharmacy Association.

'It could save a life'

Gutenberg said the association is working with the College of Pharmacists of B.C. to get training and take-home materials ready for patients, if it comes to that.

"They'd have to be able to draw it out themselves," said Dr. Donald Stark, a Vancouver allergist who has offered that option to patients who can't find EpiPens.

The difficulty is, in a panic situation, self-administering is not easy.

"It's a little more cumbersome and anxiety-provoking to do it that way but it could still save a life."

Anyone with an expired EpiPen should still use it, as the dose may be less effective but not harmful, said Stark.

EpiPen products expire on the last day of the month indicated on the package, so those with an August expiry date are good until Aug. 31.

Health Canada says anyone who has an anaphylactic reaction but has only an expired EpiPen should use the expired product and immediately call 911.

Manufacturers say inventory management can be challenging, in part because of the EpiPen's short shelf life. (Rich Pedroncelli/Associated Press)

With files from Jean Paetkau and Andrew Kurjata

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