Officials cope with EpiPen shortage
Public urged to hold on to expired devices in case of emergency
A critical shortage of adrenalin auto-injectors has a leading B.C. expert urging patients to hang on to expired EpiPens because they still might save their lives if they have a severe allergic reaction.
And B.C. pharmacists are expected to start training parents and caregivers within a week on how to draw adrenalin into a conventional syringe and to inject it in an such an emergency, known as anaphylaxis.
An estimated three million Canadians have serious food allergies.
“One thing I am discussing with patients is that they should hang on to their expired devices and use them even if they are past the expiry date because there is some evidence that they still contain active ingredients for up to two years past the expiry date,” said Dr. Edmond Chan, head of the division of allergies and immunology at B.C. Children’s Hospital.
“It’s not ideal, but it’s better than nothing. We don’t want people to hesitate to use EpiPens that have expired. But then they have to call an ambulance to get to a hospital right away.”
Production problems at Pfizer, the company that makes the EpiPens available in Canada, means stocks at some pharmacies could run out in August before a new batch arrives, Health Canada warned this week. EpiPens are designed to automate and speed up the process of injecting adrenalin in an emergency. They typically have a shelf life of up to 18 months.
Chan said the shortage has been developing for several months but is expected to peak in August.
That could mean an increase in emergency department visits by people who fear they are developing symptoms of anaphylactic shock or full-blown anaphylaxis.
Worse, the shortage comes at the time of year when people allergic to bee stings are most likely to be stung.
Symptoms of anaphylaxis include a drop in blood pressure, breathing difficulties, gastrointestinal problems, hives or itchy skin, and severe anxiety. Adrenalin, also known as epinephrine, is recommended as an immediate antidote.
Antihistamines like Benadryl are not recommended as they don’t act quickly and will mask symptoms.
Chan said patients with symptoms or a history of anaphylaxis are better off going to a hospital in an ambulance because “they ’ll get the immediate attention of ER staff.”
He also advises patients to be diligent about reading food labels so they can avoid allergic reactions in the first place.
A study in 2014 showed that 80,000 patients went to emergency departments in Alberta and Ontario, just under 10 per cent of them in full-blown anaphylaxis.
Chris Chiew, general manager of pharmacy operations for London Drugs Ltd., said his chain has managed its supply and can still fill prescriptions. But he’s pleading with customers not to panic or stockpile the medication.
“We’re asking people to ensure they have one or two EpiPens on hand, but don’t try to stockpile more doses, because that’s what will cause a serious shortage in communities.”
Linda Gutenberg, the deputy CEO of the B.C. Pharmacy Association, said the organization is in discussions with the College of Pharmacists of B.C. about pharmacies selling customers glass ampoules of epinephrine and injection equipment when EpiPen supplies vanish. The service may start as early as next week, because in places like Kamloops, the EpiPen supply has run out, she said.
“We’re looking at a program in which some pharmacists will train customers who are caregivers how to break open the glass ampoule and draw up the correct dose into a syringe to inject into an individual.”
Dr. Donald Stark, a Vancouver allergist-immunologist, said the dwindling EpiPen supply is causing people to do foolish things. He’s heard patients say they’ll go to hospital to get an epinephrine injection instead of using their EpiPen. But doctors say it’s a dangerous practice and that patients should use their EpiPen as soon as symptoms start and then call an ambulance.