Health Care in Canada needs to see a pharmacist.

Canadians have long been proud of our system of universal health care, but it is well known that the system has been struggling to keep up with our evolving health care needs.

With an aging population, new technologies and economic pressures on families and governments, we need to find health care solutions that will apply our health resources effectively and sustainably and provide care where and when people need it most.

Pharmacists are highly educated medication experts and the most accessible health care providers, seeing approximately 10 million patients each week across the country. They provide care and services that are close to home and meet the unique needs of their patients and communities.

As the most frequent point of contact between Canadians and the health care system, pharmacists can attest to the barriers faced by patients in accessing medications and health care services.

Therefore, we are calling on parties to demonstrate their commitment to addressing these barriers and making the following health care issues central to their election platforms:

An Action Plan to Address Drug Shortages

Drug shortages, recalls and discontinuations are a growing problem in Canada. According to a national poll, 25% of Canadians have either personally experienced or know someone who has experienced a drug shortage in the last three years.[1]

Pharmacists encounter drug supply issues on a daily basis and they work hard to reduce the effects of these disruptions on their patients. They work with suppliers, prescribers and insurers to source affected medications, identify alternatives and counsel patients on changes to their medication therapy. However, they know that switching medications comes with increased health risks and anxiety for patients.

Beyond the health consequences, drug shortages are also increasing the costs of health care. Patients may need to travel or miss work to obtain a new prescription or purchase alternative products not covered by their drug insurance. Public and private payers must find and list potentially more expensive alternative products. Health care practitioners also devote a significant amount of time and resources to managing drug shortages — resources that would be much better spend on improving patient care. We urge political parties to make this issue a priority in the upcoming election and outline a plan to ensure that Canada has a stable drug supply. This is especially urgent considering U.S. plans to import Canadian medications, which could exacerbate shortages.

CPhA is seeking a commitment from federal parties to implement a comprehensive action plan to ensure that Canada has a stable drug supply. This plan should include:
  • Research into the causes and solutions of drug supply issues
  • Leadership on the international stage to enact tangible solutions to this problem
  • Supports for frontline health care providers who are struggling to manage supply disruptions
James Morrison, Pharmacist

“Recently, one of my patients’ blood pressure medications wasn’t available because of a shortage. Switching this patient to an alternative drug was really challenging. We tried three different replacement medications before we could find an alternative that was effective and tolerable for them.”

James Morrison, Pharmacist, Burlington, ON

[1] Abacus Data. (2018). Drug Shortages: A Survey of 1,500 Canadian Residents. https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/DrugShortages_AbacusSurvey_November2018.pdf

Reducing the Risk of Opioid Dependency

The opioid epidemic is one of the most challenging and complex health crises in Canada today. Between January 2016 and December 2018, a reported 11,577 Canadians died of an apparent opioid-related overdose. Another 4,460 deaths were caused by opioids in 2018 alone.[2] Statistics Canada recently reported that for the first time in four decades the life expectancy of Canadians did not increase from 2016 to 2017, which is largely attributed to the opioid crisis.[3]

Pharmacists are still seeing prescriptions for high initial doses or durations of opioid therapy and are often the first health care providers to see signs of dependency in patients.

Most opioid overdoses involve street drugs, but it is not uncommon for dependency problems to begin with opioid prescriptions, many of which are unnecessary or inappropriate. This issue has received much attention in recent years, but change has been slow. Pharmacists are still seeing prescriptions for high initial doses or durations of opioid therapy and are often the first health care providers to see signs of dependency in patients.[4],[5]

As we approach the 2019 election, pharmacists are asking all political parties to commit to improving the safe and effective use of prescription opioids by expanding prescription opioid monitoring programs and supporting provinces and territories to ensure they have the best tools and technologies for this task.

Pharmacists are a valuable resource in this effort. A simple regulation change at the federal level could enable pharmacists to assess initial and ongoing opioid prescriptions to make sure they are appropriate for their patients. If necessary, pharmacists could then make changes to minimize the risk of harm to patients by reducing the dosage or duration of opioid therapy and switching patients to alternative therapies, where appropriate. This regulation change would also add pharmacists to the team of health care providers authorized to manage opioid tapering and dependency treatment, thus increasing capacity and patient access to these essential services.

We are calling on all federal political parties to support a comprehensive program to minimize the harms associated with prescription opioid use with a focus on three priority areas:
  • Improved monitoring to intercept inappropriate opioid prescribing
  • Counselling and education programs for first-time opioid patients
  • Increased capacity and access to opioid tapering and dependency treatment options
[2] Government of Canada. (2019). National Report: Apparent Opioid-related Deaths in Canada.
https://health-infobase.canada.ca/datalab/national-surveillance-opioid-mortality.html#AORD
[3] Statistics Canada. (2019, May 30). Changes in life expectancy by selected causes of death, 2017.
https://www150.statcan.gc.ca/n1/daily-quotidien/190530/dq190530d-eng.htm
[4] National Pain Centre. (2017). The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain.  http://nationalpaincentre.mcmaster.ca/documents/Opioid%20GL%20for%20CMAJ_01may2017.pdf
[5] Ireland, N. (2019, June 6). Sask. does not monitor opioid prescribing practices, dispensing at the province’s pharmacies: Auditor’s report. CBC News.
https://www.cbc.ca/news/canada/saskatchewan/sask-opioids-audit-pharmacies-auditors-report-1.5164753

Improving Access to Community Care

The Canadian health care system is struggling to meet our health care needs. Too many Canadians do not have a family doctor, or they may wait weeks for an appointment. Access to specialist care is even worse. Patients often find themselves in overcrowded emergency rooms or hospital hallways, often for treatable but highly complex conditions. Health care workers and caregivers are burning out. And seniors are deteriorating while they wait for placements in long-term care facilities.

Improving community-based health care is critical to addressing many of the strains on the health care system, including the ineffective use of resources. It will also improve patient experiences by expanding access to care closer to home.

There are many opportunities to achieve this goal, including better use of health professionals like paramedics, pharmacists and midwives, who should be enabled and supported to practice to the full extent of their skills and abilities.

In fact, many studies have shown that these providers can improve patient outcomes and reduce health care costs, and yet they remain underutilized and underfunded.

Community pharmacists, for example, are helping to provide patients with faster and more convenient access to health care. In the case of women’s health, pharmacists are transforming how women obtain treatment for urinary tract infections (UTIs) and access to birth control. Nearly 30% of women take oral contraceptives, and urinary tract infections affect half of women by the time they reach their early thirties[6][7]. UTIs are also one of the top reasons people end up in emergency rooms.

Pharmacists can now treat and prescribe for these health issues in certain provinces, which is helping women avoid unnecessary trips to emergency rooms and providing women with faster, more convenient care in their communities.

Beth Kessler, Pharmacy Manager, Regina, SK

“It is very gratifying to help women have easier access to birth control and treatment for urinary tract infections (UTIs). UTIs are common infections that are landing women in clinics, when many can be easily treated in the pharmacy. Also, women are spending a lot of time waiting in doctor’s offices to renew their birth control prescriptions, which is often something they’ve been using for many years. When these women are told that we can take care of their birth control prescription or treat their UTIs in the pharmacy, the look of relief on their face shows the importance of easy, timely access to these women’s health services.”

Beth Kessler, Pharmacy Manager, Regina, SK

Pharmacists can also treat patients for other common conditions like gastric reflux and shingles, give vaccines and help patients manage complex chronic conditions like diabetes. These programs are especially important in rural and underserviced areas or where patients do not have access to a family doctor.

We are urging Canada’s political leaders to invest in and expand access to community-based health care by leveraging the skills of community-based health professionals.
[6] Statistics Canada. (2015). Prevalence of oral contraceptive use, by selected characteristics, women aged 15 to 49, household population, Canada, 2007 to 2011. https://www150.statcan.gc.ca/n1/pub/82-003-x/2015010/article/14222/tbl/tbl1-eng.htm
[7] Beahm N, Smyth D, Tsuyuki R. (2018). Outcomes of Urinary Tract Infection Management by Pharmacists (RxOUTMAP): A study of pharmacist prescribing and care in patients with uncomplicated urinary tract infections in the community. https://doi.org/10.1177/1715163518781175

Improving Drug Coverage for Canadians with a Sustainable Pharmacare Plan

Half of Canadian adults currently take at least one prescription drug and 40% of seniors and those with chronic diseases take four or more[8]. Despite the importance of medications in treating our health problems, many Canadians simply cannot afford them because they do not have access to drug insurance, or they may only have partial coverage.

For pharmacare to succeed, patients also need to get the most out of their medications.

Pharmacists believe that all Canadians deserve access to medically-necessary medications and services that support optimal medication use. We also believe that an equitable and sustainable pharmacare program can be achieved while respecting provincial/territorial responsibility over health, minimizing disruption for patients and building on the effective mix of public and private programs that currently exist across the country[9]. For example, a national list of drugs – also known as a formulary – could provide a minimum standard for all drug plans and end the current patchwork of coverage between public and private plans.

For pharmacare to succeed, patients also need to get the most out of their medications. Pharmacists are essential to achieving this goal by providing medication counselling and monitoring patients’ therapies to ensure safety, adherence and the best possible health outcomes. Pharmacists also help patients withdraw from medications that are no longer safe, appropriate or effective. These services benefit patients but also reduce waste and costs in the health care system.

An equitable and sustainable pharmacare program can be achieved while:

  • Respecting provincial/territorial responsibility over health
  • Minimizing disruption for patients
  • Building on the effective mix of public and private programs that currently exist across the country

While any pharmacare program will take time to implement, steps can be taken in the short-term to improve drug access. For instance, funding could be provided to provinces and territories to expand public drug coverage to those without coverage. Federal funding could also be used to improve and harmonize programs to limit out-of-pocket drug costs for patients – also known as catastrophic drug coverage – which are essential for patients with rare diseases or with limited coverage. A federal drug transfer, much like the current Canada Health Transfer, could be established to support this effort.

We are urging political parties to prioritize drug access and coverage for all Canadians. Timely and practical strategies to achieve this goal should include:
  • Expanding drug access to Canadians who are uninsured and underinsured by building on the effective mix of public and private drug plans already in place
  • Funding for provinces to improve and harmonize catastrophic drug coverage across Canada in order to better support those with rare diseases or limited drug coverage
  • Implementing a comprehensive minimum national drug list or formulary
  • Prioritizing the optimal use of medications and pharmacist care for improved patient outcomes
[8] Statistics Canada. (2015). Prescription medication use by Canadians aged 6 to 79.
https://www150.statcan.gc.ca/n1/pub/82-003-x/2014006/article/14032-eng.htm
[9] Canadian Pharmacists Association. (2017). Rx: PharmAccord. A Prescription for a Healthier Canada.
https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/PharmAccord_Final_Online.pdf

Better Access and Care for Medical Cannabis Patients

Pharmacists in Canada believe that medical cannabis patients deserve the best possible care from health care providers and improved access to medical cannabis therapy. The reality is that the legalization of recreational cannabis has created an environment where patients have greater access to recreational cannabis than they do to medical cannabis, and patients are being marginalized with limited support and counselling.

Pharmacists believe that medical cannabis patients deserve the best possible care from health care providers and improved access to medical cannabis therapy.

With no product differentiation, limited insurance coverage and significant barriers to access, patients have little incentive to seek a legitimate medical document from a health care provider and obtain medical cannabis through the medical stream. In fact, a recent survey commissioned by CPhA, Canadians for Fair Access to Medical Marijuana and the Arthritis Society found that since legalization, the majority of medical cannabis users in Canada (61%) are self-medicating, left to seek health advice from retailers or other unqualified sources.

They are also commonly accessing cannabis for medical purposes through the illegal market and using cannabis in combination with other prescribed medications.[10] Even where medical cannabis patients seek out a health professional for a medical document, these patients are still denied consultation with a medication expert who can help patients avoid drug interactions, advise on proper dosing, provide the appropriate follow-up care and contribute to data collection and research.

Pharmacists are recommending that federal policy makers establish clear policies that differentiate the medical and recreational cannabis streams and improve access and care for medical cannabis patients. These policies should:
  • Establish product differentiation between recreational and medical cannabis
  • Expand medical cannabis research to support safer, more effective prescribing and methods of administration
  • Provide patients with incentives to obtain cannabis through the medical stream to ensure they receive the appropriate clinical oversight
  • Restrict the sale of all products that make a health claim and contain cannabis, including THC, CBD and all other cannabinoids, to pharmacies where pharmacists, as medication experts, can provide the appropriate counselling and oversight at the point of sale
[10] Abacus Data. (2019) CPhA Medical Cannabis Study: Medical Cannabis Users. https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/Cannabis%20Survey_Patients-GenPub.pdf

Acting on these priority issues with innovative thinking and a creative use of health resources will help us achieve an effective and sustainable health care system that we can be proud of;

one that will benefit all Canadians and help us live better, healthier lives.