How an essential medicines list could benefit Canadians

Unlike more than 100 members of the World Health Organization, Canada doesn't have a list of essential medicines. Creating one could help alleviate drug shortages and improve prescribing practices, doctors say.

Guaranteeing supplies of key drugs may help prevent shortages and ensure better prescribing

Creating and enforcing an essential medicines list of prescription drugs that Canada commits to supplying at all times could help alleviate drug shortages and improve prescribing practices, doctors say.

Unlike 117 other member countries of the World Health Organization, Canada has no such list.

Norway has kept a list of essential medicines since 1928, and few drug shortages have been reported in that country. Sweden's "wise list" of 200 drugs is trusted by practitioners, who have seen cost savings and improved quality of care because of it, previous research suggests.

Drug shortages can be dangerous. At points over the past few years in Canada, children with controlled epilepsy seizures have had difficulty accessing vital medication, cancer patients have had their recommended chemotherapy treatment interrupted or stopped, and epinephrine auto-injectors used to treat anaphylactic allergic reactions have been in short supply

In Monday's issue of the Canadian Medical Association Journal, Dr. Jacalyn Duffin, a hematologist at Queen's University in Kingston, Ont., and her colleagues present a case for an essential medicines list for Canada.

An essential medicines list includes between 200 and 500 medicines that a government commits to keeping in stock because officials consider them high priorities. (Lists vary from country to country, based on local needs.) 

Drugs on the list are the gold standard, with proven effectiveness and safety, said Duffin, who also holds the Hannah Chair in the history of medicine at Queen's.

Doctors and other health-care providers would remain free to prescribe medications beyond those listed — currently more than 8,000 pharmaceutical drugs are licensed for sale by Health Canada 

Canadians unknowingly affected?

Duffin runs a website compiling drug shortage information but notes no one can keep on top of all 8,000 approved medications. The essential list would create a manageable number of medications to supply while Canadians get a handle on the extent of drug shortages, and guide prescribing practices while controlling drug costs, the authors say.

"I think that people are affected by the drug shortage and don't even realize it," Duffin said in an interview. They'll say  "'Oh, my doctor changed my medicine. It costs a lot more and it's a new drug so it must be better.' They assume that the doctor is just looking after them properly and the doctor is … But on the other hand, doctors don't have any guidance as to how to solve the problem when the drug the patient has relied on for a number of years suddenly goes missing."

Drugs are also sometimes difficult to obtain, Duffin's team acknowledges, because global shortages can limit supplies. They say the list of essential medicines could improve availability and help governments to avoid or mitigate shortages.

The authors are calling for strong political action to support the creation of the list. The essential medicines list could also be a key component to a Canadian national pharmacare plan, the authors say.

The World Health Organization promotes an essential medicines list and developing countries have reported benefits, although rigorous data are lacking, Duffin's team said.

Prime Minister Justin Trudeau's mandate letter to the minister of health included a commitment to "improve access to necessary prescription medications."  Last month, the federal government said that mandatory reporting of drug shortages will be made public through a website and app. 

With files from CBC's Amina Zafar