Help Reduce Backlog for EpiPens in Canada

Medical practitioners have the means to use alternative measures other than EpiPens in the event of emergency allergic reactions in their clinics. 

The months-long supply shortage of EpiPens in Canada may finally be coming to an end. But Health Canada warns it might take months to clear the backlog of orders for the life-saving epinephrine auto-injector.

Healthcare professionals in Canada can do their part to ease this crisis simply by not purchasing new EpiPens when they become more readily available. There are alternative solutions available in case of emergency allergic reactions, and medical practitioners and clinicians should use them now and in the future.

Children who need EpiPens should be a priority

Health Canada first announced a supply shortage of EpiPens back in January. The situation became critical in August as supplies began to run out completely at pharmacies.

Pfizer Canada markets EpiPen injectors in Canada for people who are at risk of suffering anaphylaxis, a life-threatening allergic reaction that can be triggered by things such as peanuts and insect stings. Christina Antoniou, senior manager of corporate affairs at Pfizer, told Allergic Living that “we are anticipating a period of four weeks (through August) where no inventory of EpiPen 0.3 mg will be available.”

While Pfizer will begin providing new supplies at the end of August, Dr. Supriya Sharma, chief medical adviser at Health Canada, told Global TV News that she expects that a backlog in demand for EpiPens will drag on for months, possibly into 2019.

“It won’t be as extreme as not having any supply at the pharmacy level but there will still be limited supply,” said Dr. Sharma. “When we go out and we talk about a shortage, we don’t want to trigger people to get panicked.”

Certainly, there is no need for the healthcare profession to panic. Providers and practitioners should resist the temptation to purchase or stockpile EpiPens for emergency use in clinics. Let people who have urgent needs – and especially children returning to school –  have priority access to EpiPens in pharmacies.

Here’s what Oriol Rhodes RN, a medical aesthetics practitioner and trainer at THMA Consulting, proposes we do in our clinics.

By using the ampoules of epinephrine to stock our clinics, we will be able to respond safely to severe allergic reactions in our clinics while also reducing the public demand for the much-needed EpiPen auto injectors.

The healthcare provider would draw up the epinephrine (1:1000) from the ampoule in a 1cc syringe. For patients over 30kg the dose is 0.3 – 0.5 mg (0.3 – 0.5 mls) of undiluted epinephrine. The medication would be injected SC/IM once in anterolateral aspect of the thigh, and is not to exceed 0.5 mg (0.5ml) per injection.

This dose may be repeat every 5 to 15 minutes as necessary. It should be noted that repeat injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis.

Meanwhile, pharmacies will likely limit purchases of EpiPens to one per person from now until the situation stabilizes. The federal government has also ordered importation of a U.S.-approved auto-injector called Auvi-Q to ease Canada’s current shortage of EpiPen injectors.

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

Pfizer blames the shortage on a recurring manufacturing issue at its plant in Missouri.