Canada Facing Nationwide Shortages of Opioid Pain Medication
/By Pat Anson
Pain patients in the United States have been dealing with persistent shortages of opioid pain medication for years. Now their counterparts in Canada face a similar issue.
Health Canada has issued a warning about nationwide shortages of oxycodone and acetaminophen combinations, along with medications that combine codeine with acetaminophen. Acetaminophen and oxycodone are sold under the brand names Percocet and Endocet, while acetaminophen-codeine combinations are often sold as Tylenol #3.
While the opioid shortages in the U.S. appear to be largely driven by a national opioid settlement that rations pain medication at the pharmacy level, the Canadian shortages are being blamed on manufacturing disruptions and increased demand.
“We recognize the importance of having acetaminophen with codeine or oxycodone products available for patients. Addressing this shortage is a top priority,” Health Canada said in a statement.
“We're communicating with health care providers, provincial and territorial governments, and distributors to coordinate the sharing of information about this shortage. We're also working with manufacturers and stakeholders to monitor the supply of acetaminophen with codeine or oxycodone and looking at options for increasing access to these products.”
The Canadian Pharmacists Association (CPA) expects the shortages to last a few more weeks, when a “significant resupply” is expected.
“Widespread supply constraints are expected to persist until early August, when a significant resupply is anticipated,” the CPA said in a statement, without explaining where the new supply is coming from.
Until the shortages ease, the CPA is advising pharmacists to suggest non-opioid pain relievers for patients suffering from acute short-term pain, such as headaches and muscle strains. For long-term pain patients already using oxycodone and codeine combinations, the CPA recommends limiting doses to 90 morphine milligram equivalents (MME) a day. Anyone above that dose should be tapered..
“If the current dose is high, give 50% or less of the new opioid converted to morphine equivalents. Otherwise, start with 60–75% of the previous dose converted to morphine equivalents,” the CPA said.
In the United States, either scenario would be considered a rapid taper, which raises the risk of an overdose or mental health crisis. The CDC recommends more cautious tapering of patients, with a dose reduction of just 10% a month.
The American Society of Health-System Pharmacists (ASHP) first reported U.S. shortages of oxycodone-acetaminophen combinations in the summer of 2023. Not much has changed in the last two years.
In its June report, the ASHP said several drug manufacturers have oxycodone-acetaminophen combinations on back order, with no estimated resupply date. Only one drug maker, Major Pharmaceuticals, anticipates having new supplies in early August.
Some companies are phasing out the production of opioid medication. Endo Pharmaceutical stopped making Percocet in 2024, while Teva Pharmaceuticals discontinued production of immediate release oxycodone in 2023 and Transmucosal Immediate-Release Fentanyl Medicine (TIRF) in 2024. Opioid litigation has been very costly to Teva and other drug makers. In 2022, Teva paid $4.25 billion to settle thousands of opioid liability lawsuits.
