TORONTO -- As governments attempt to address the dwindling stock of masks, tests and ventilators needed during the COVID-19 pandemic, a national group of physicians is warning of another supply threat.
Painkillers and sedatives are potentially weeks away from a 鈥渃ritical shortage,鈥 the Canadian Association of Emergency Physicians (CAEP) said in a Tuesday.
鈥淭his would have significant clinical impact and therefore requires immediate investigation and action,鈥 the group said.
While the issue of ventilator access has been particularly dire, the group said, some attention needs to be paid to the supply of the medications required to operate the ventilators.
There has been no documented shortage in Canada yet, said Dr. Alan Drummond, co-chair of public affairs for the CAEP in an interview with CTVNews.ca. But the group is calling for hospitals and governments to determine the state of the supply of the drugs in question, which include sedatives (propofol), benzos (midazolam), painkillers (fentanyl and morphine) and paralytic agents (succinylcholine and rocuronium). The drugs are used every day in emergency departments, intensive care units and operating rooms.
鈥淚f there is (a shortage), or there鈥檚 a potential shortage in the offing, then let us know,鈥 Drummond said Tuesday via telephone. 鈥淯nder those circumstances, we could do our bit in terms of modifying the medications and techniques we use in the emergency department.鈥
The new call comes after weeks of following developments in other countries, hearing anecdotal evidence from various CAEP members around the country, and following official provincial action. In Quebec, Premiere Francois Legault has stated that the province anticipates a shortage of anesthetic medications, while in Ontario, Drummond said hospitals have been asked to complete inventories, though there has yet to be any official word on stock levels.
鈥淭hat indicates that A) they don鈥檛 know, and B) they may well be concerned. We鈥檙e just trying to get ahead of the curve here,鈥 said Drummond, adding that there have been notable shortages of the drugs in the U.S. and Europe. 鈥淪ince this is a complex global phenomenon, I wouldn鈥檛 be surprised if there were potential shortages in Canada.鈥
A shortage could have devastating consequences for patients who can鈥檛 control their breathing, some of whom may even develop delirium on top of the painful, anxiety-inducing process of ventilation. Not only may an increasing number of coronavirus-infected patients require these drugs, but they鈥檒l likely need more of them, said the CAEP.
鈥淐OVID patients appear to require the support of a ventilator for longer times than other ICU patients and, as such, require more of these essential drugs,鈥 the news release said.
The CAEP is calling on authorities to develop processes as the local level to inform physicians of stock levels and possible drug alternatives, including older medications. The group wants a 鈥渘ational review鈥 of the supply, distribution and management of the drugs across provinces, as well as 鈥渘ational management鈥 of procurement, production and distribution of the drugs.
At the clinical level, emergency physicians should reduce drug waste and use alternative techniques and painkiller options if appropriate, the group continued. Drummond said that physicians are 鈥渨ell-schooled鈥 in the medications potentially at risk, so the pandemic may require a cognitive shift for doctors.
鈥淚t鈥檚 always good to choose wisely the medications and techniques used. It may mean a greater focus on the use of regional nerve blocks, of joint injections, of using drugs like ketamine, which is kind of a third-world disaster-type medicine for sedations,鈥 he said.
鈥淲e just have to readjust our thinking a little bit to say 鈥楾hese drugs would be ideal, but we can use less-than-ideal drugs if necessary to get the job done to provide pain relief and compassionate care.鈥欌
