Can't find children's pain meds? Here's a pharmacist's advice

While an emergency supply of children's pain medication on its way to hospitals, the former chair of Nova Scotia's pharmacy association says pharmacies will likely be waiting a little longer.

There has been a shortage of children's pain and fever relievers, such as Advil and Tylenol, since the summer. 

Doctors elsewhere in the country believe it's led to crowding at some ERs, although Dr. Katie Gardner with the IWK Health Centre told CBC Nova Scotia last week it's difficult to draw a direct link between the surge of young patients to the hospital and supply issues.

The IWK, the only children's hospital in the Maritimes, has been seeing as many as 150 kids a day in its emergency department, with many coming in sick with respiratory infections that aren't COVID-19.

Information Morning Nova Scotia host Portia Clark spoke with pharmacist Curtis Chafe, former chair of the board of directors at the Pharmacy Association of Nova Scotia, about what parents can do as they wait for supplies to increase.

Their conversation has been condensed, and edited for clarity.

You can listen to the full interview here:

What do you tell people when they come in looking for these products because they have a child who's sick?

Sometimes it's a bit of a difficult conversation. I know a lot of pharmacies over the past little bit have been limiting supplies, kind of keeping them behind the counter. The manufacturers are trickling them through so most stores are on allocation, which means that they can get a small amount. But, I mean, most of the time as soon as it comes in, it's out the door again. 

So, if somebody can't find something, it's still OK for them to call around. They may be able to find something. Usually the allocations will come through once a week or something along those lines.

As far as making compounds, can you tell me a bit about where those are available if there's nothing on the shelf or behind the counter?

Pharmacists have been making medications, formulations ever since we became pharmacists and making some ibuprofen or some acetaminophen is no different. We do have formulations that have been tested, both for stability and safety and a lot of pharmacies are ordering in the raw ingredients. So you'll buy acetaminophen powder, you'll get what you need for the base and mix it up at the store level.

So, most pharmacies offer that, or how many?

In Nova Scotia, pretty much every pharmacy has to do a basic level of compounding. Some things are a little bit more complicated. Sometimes you need some specialized equipment to make it a good quality product. Something like an acetaminophen suspension is considered a basic compound and so most pharmacies would be able to do that.

I think the only thing that would limit them is whether or not they've actually ordered in those ingredients to be able to make it. And that depends on what the demand is at their particular store. I'm sure if anybody had a conversation with their pharmacist, they would let them know whether or not they have that capacity to do it. 

Even if your home pharmacy doesn't do it right now, or it doesn't have plans in compounding, usually we all have that one, or two, compounding pharmacy that's in our back pocket to send people to just so that they don't go without. 

Do you have advice for caregivers about giving their children smaller doses of adult medications, whether to do that and how to do that safely?

It's never a good idea to kind of use different formulations for kids. You know, with children's medication, pediatrics, we'll take their weight, we'll look at their age and then we'll find out what their appropriate dose is. 

I was a big kid. When I was younger I started on adult stuff, you know, relatively early, but for the most part you're going to want to have that conversation with the pharmacist at least to find out what the appropriate dose is. Sometimes you can give half of the tablet of an adult dose and it's absolutely fine, but I wouldn't just go Googling that or anything, I'd have a conversation with a pharmacist first.

What's your understanding of why this is happening, how we've come to this shortage?

From what I hear — and I've heard a couple of things — but number one is that for some reason demand just started to really outstrip supply. Manufacturers will look to see what they have sold in the past couple of years. 

I probably say another three to four months where supply is going to be a little bit hard to come by.- Curtis Chafe, PANS

Usually, you know, a non-prescription pain reliever has about a three-year expiry life or shelf life. The past couple of years there hasn't been too much in the way of fevers, there hasn't been too much in the way of any kind of respiratory illnesses. And so, not to say that they've kind of reduced it, from what I understand they actually have increased their supply for 2022-23. But even then the demand outstripped. Then all you need is to see a couple empty shelves on Facebook or you know hear about it on the radio or on news and then everybody gets into a little bit of a frenzy. And you head out to the pharmacy and you try to grab what you can get to keep it in your house … From what I understand, the demand was up about 200 per cent.

We're hearing that Health Canada is getting some emergency supplies from places like the U.S. and Australia that will go to hospitals. When might we see more supply in pharmacies and drugstores?

From what I've been told, probably not until some point in 2023 so we're in this for quite a few months. This is only November now so, you know, conservatively, I probably say another three to four months where supply is going to be a little bit hard to come by.

Update, Nov. 14, 2022, 3:20 p.m. AT: Health Canada released a statement saying "we have secured foreign supply of children's acetaminophen that will be available for sale at retail and in community pharmacies in the coming weeks."