TORONTO — The Ontario Medical Association has released a white paper outlining fears that rising COVID-19 cases and hospital admissions could limit drug supplies in coming weeks.

OMA president Dr. Samantha Hill said chronic drug shortages have worsened during the pandemic and may become more serious if hospitals are overwhelmed. 

That includes essential and critical care medications propofol, ketamine, succinylcholine, fentanyl, and midazolam.

"Drug shortages can be catastrophic for patients, causing treatment delays, increased suffering, financial burden and an increased risk of overdose and underdose," Hill said Tuesday in a release.

China and India supply most of the active pharmaceutical ingredients used in North America. 

The OMA is urging all levels of government to work towards a long-term goal of increasing the country's ability to manufacture and stockpile essential drugs.

A coalition of Canada's doctors, pharmacists and citizens raised similar warnings in August, noting many in-demand drugs are used to treat COVID-19 and are also used in operating rooms, emergency departments and palliative care settings.

The Critical Drugs Coalition warned of possible shortages in the event of a winter surge of COVID-19, and now that the second wave has strained health-care systems in several hotspots, the OMA suggested we're nearing the precipice of rationing drugs.

Dr. Bjug Borgundvaag of the Canadian Association of Emergency Physicians said the pandemic has especially increased demand for steroids, antibiotics and drugs used for sedation, pain, and blood pressure.

"Drug supply so far is still OK but it's very unpredictable," said Borgundvaag, director of the Schwartz/Reisman Emergency Medicine Institute at the Sinai Health System.

"The pharmaceutical companies do not have the capacity to suddenly double or triple drug manufacturing, and it's very hard to anticipate something like this where the demand can go up to three or four times normal use."

Uncertainty over more infectious COVID-19 variants further complicates the difficulty in predicting ICU demands, he added.

Borgundvaag said doctors were doing what they could to conserve medication and lobby pharmaceutical manufacturers for greater drug allotments.

The OMA warned that drug shortages can seriously affect patient care and "force health-care providers to make very difficult choices."

This report by The Canadian Press was first published Jan. 19, 2021.

Cassandra Szklarski, The Canadian Press