Glen Patton says he’s not one to panic.
But a global shortage of the diabetes drug Ozempic has diabetics like him rattled — he says access to the medication could mean the difference between life and death for him.
Its shortage is something experts partly attribute to a trend of the drug being prescribed for the off-label purpose of weight loss.
Health Canada said it hasn’t approved Ozempic for weight loss.
“As a retired fireman … it takes a lot to shock me,” said Patton, a resident of South Lancaster just east of Cornwall, Ont.
“For me to walk into a pharmacy and ask for my prescription and be told, ‘Well, we don’t have it, we might not get it, you might want to start checking other pharmacies, and maybe by next March we’ll have it’ — is like, whoa, whoa, whoa.”
Marketed as Ozempic, the semaglutide injection is currently approved by Health Canada for the treatment of Type 2 diabetes. Semaglutides mimic a hormone that both encourages the body to produce insulin and, in higher amounts, affects the part of the brain that reduces appetite.
Health Canada previously stated that temporary supply disruptions of Ozempic one-milligram injection pens were to be expected from late August to early October, but that lower-dose pens would still be available across the country.
However, in an emailed statement this month, a Health Canada spokesperson said “intermittent shortages” of high-dose pens and lower-dose pens are ongoing. The department said the shortage will likely persist until March 31, 2024.
A spokesperson for the manufacturer of the drug, Novo Nordisk, attributed the shortage to “overall global supply constraints coupled with increased demand.”
Patton, who only has a three-week supply of his medication left, said he can’t afford to wait until March.
“Now I inject and I’m thinking, no, I got two pens, I got two needles left. So what am I going to do after the third?” he said.
“It is on [my] mind every single day.”
Searching for supply
Patton was diagnosed with diabetes nearly six years ago, and was prescribed Ozempic about three years ago.
Last month, his local pharmacy told him they did not have any one-milligram pens, and gave him multiple lower-dose pens that would last him a few weeks instead, he said.
Patton then started calling pharmacies around town to ask if they could fill his prescription. After being told no by six different pharmacies, he reached out to extended family members across Canada to ask for their help in locating a pharmacy that had the drug.
“None of them could find it,” he said. “I was quite distressed and upset.”
Patton said his doctor then suggested an alternative medication — one he stopped taking three years ago after experiencing near-fatal side-effects such as sudden and steep drops in his blood sugar levels.
That’s why Patton said Ozempic was “life-changing.”
“There’s a big difference if you’re taking it to lose 20 pounds for the Christmas party, as opposed to it’s keeping you alive,” said Patton.
He’s worried about the serious health consequences of not having the medication, and having to go back to his old medication.
Pharmacists in a fix
According to Barry Power with the Canadian Pharmacists Association (CPhA), Patton’s story is not unique.
Power said he’s hearing from pharmacists across the country that they are turning away patients because of the Ozempic shortage.
Some pharmacies are still getting small supplies sporadically, Power said, leaving pharmacists to decide whose prescriptions to fill.
“The insecurity around the drug supply is adversely affecting the delivery of health care,” Power said.
He added that an internal survey conducted by CPhA found that between 25 and 50 per cent of prescriptions for Ozempic at pharmacies across the country are for weight loss.
Weight loss trend driving shortage
The problem is that many of those prescriptions are for people who neither have diabetes nor chronic obesity issues, said Dr. Judy Shiau, medical director of Leaf Weight Management Clinic in Ottawa.
“There’s been almost an overuse of it, and certain parties … may be using it more for other purposes such as a cosmetic reason,” said Shiau.
“It’s the TikTok phenomena.”
She added that many online pharmacies purporting to sell the drug may be doing so without appropriate checks in place— making them an attractive avenue for those looking to lose weight quickly, but further worsening the situation for diabetics.
Still, Shiau said the drug is “very meaningful” for obesity management. She explained Health Canada approved semaglutide, marketed as Wegovy, for the purpose of weight loss about two years ago — but that drug never came to Canada. As a result, clinicians turned to Ozempic, which is a different format of the same drug.
“Unfortunately, we are kind of pitting diabetes versus obesity management and it’s not fair to the patients [and] it’s not fair to clinicians,” she said.
Shiau said she is now minimizing prescriptions for Ozempic at her clinic, reserving them for patients who live with diabetes or serious health concerns stemming from obesity.
Power hopes other clinicians will follow suit.
“Ideally, health-care providers would realize the severity of the the shortage and adjust their prescribing accordingly,” he said.
Manufacturer apologizes for shortage
Novo Nordisk said in an emailed statement that the drug is “not marketed as a weight loss treatment,” “is not approved for chronic weight management,” and that it “does not advertise Ozempic for weight loss.”
It encouraged patients who are unable to fill their prescriptions to contact their health-care providers to discuss alternatives.
Novo Nordisk added that it apologizes to patients and health-care professionals who may be impacted.
Health Canada said in an email that while it doesn’t approve the drug being used for weight loss, “[the] decision to prescribe a drug for off-label use is part of the ‘practice of medicine,'” which is regulated by provincial and territorial colleges of physicians and surgeons.
In its emailed statement, the College of Physicians and Surgeons of Ontario said it sets out broad expectations related to prescribing, but does not set specific guidelines for any particular drug and is not involved in procurement or distribution of medications.
Patton said a lack of accountability on the part of these institutions has left him feeling helpless.
“I don’t care who it is. Somebody [needs] to step up and say, ‘OK, that’s enough. These medications are to be kept and only kept for people that need it, because you could actually totally affect their lives, the rest of their lives and their life expectancy,'” said Patton.
Health Canada said it is looking for “ways to conserve existing supply, expedite resupplies to pharmacies and access foreign-authorized supply or alternatives, if possible.”
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