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16/11/2013

Canadian drug "shortages"

Just got another email from RIH about more drug "shortages". Seems that the concepts of Nassim Taleb's book "Antifragile" haven't made it very far in the statist bureaucracy that controls every minute detail of the pharmaceutical industry in Canada.

The problem is that Sandoz is the sole supplier of many injectable drugs in Canada. Why such a situation is allowed is beyond me as it represents a single point of failure whereas a robust system would have multiple suppliers. Drugs such as lorazepam, hydromorphone and fentanyl are currently in very short supply. Now creating a drug solution of specified concentration for injection is not rocket science. As one of the GP's rather sarcastically commented at one of our hospital meetings recently, his patients have no difficulty in taking hydromorphone tablets and producing an injectable product from them. Such crude drug solutions do suffer from sterility issues; something which is readily dealt with by sterilizing the solution by passing it through a 0.2 micron milipore filter. That, and buffering it to pH 7.4 and ensuring it's isotonic to serum.

I've made sterile drug solutions of given concentration as I wanted my neural cultures to last as long as possible without bacterial infections. It was an action so simple that I was completely astounded when the shortage of injectable drugs came up as a major crisis in hospital pharmacies. The fact that pharmacists haven't been taught how to perform such simple operations is criminal.

The problem, at its root, is the absolutely insane statist regulatory climate that takes an operation as simple as dissolving the salt of a drug in normal saline and makes it into a byzantine regulatory nightmare that only the bravest (or most foolish) will attempt to navigate. Thus, we end up with a single supplier of iv drugs for the whole country whereas every junkie in Canada has absolutely no difficulty in providing themselves with injectable drugs.

To me the very existence of such a problem reflects a government totally out of control and a start in dealing with this problem would be to randomly fire every third bureaucrat and snivel servent as well as all members of the oxymoronically entitled "health protection branch". Next, one should take the totality of regulations enacted in the last 20 years and create a huge bonfire from the paper copies to erase this period of insanity from the history of the country. Then start teaching pharmacists how to dissolve a drug in a liquid -- one can use analogies like adding sugar to ones coffee. Sterile technique is easily learned and microbiology lab technicians can help out. Have hospitals prepare their own iv drugs and one no longer will have the absolutely idiotic situation where injectable drugs are not available in a whole country. Hell, I'm sure that the countries junkies would be happy to help explain how the process is done in exchange for a small donation of morphine and hydromorphone tablets.

Posted by Boris Gimbarzevsky at 1:55.20
Categories: Medical