Canada’s children’s Tylenol shortage is getting worse — and bilingual labels are part of the problem

Canada's shortage of children's Tylenol and other pain and fever medications for kids is getting worse - and one of the factors contributing to the crisis appears to be the requirement for bilingual labels.

Countries such as the U.S. and Australia have a steady supply of over-the-counter medications for children containing acetaminophen (also known by the brand name Tylenol), and ibuprofen (Advil), yet drugstores across Canada have been grappling since May with supply shortages.

There's no shortage in the U.S. You can buy Tylenol without a problem," said Joel Lexchin, an emeritus professor at York University's faculty of health, where he studies pharmaceutical policy.

The fact that this has been going on for more than six months seems to indicate that the government, at least until now, hasn't taken shortages seriously in terms of trying to resolve the problem."

One of the impediments to importing the products is Health Canada's regulations requiring that they be labelled in both English and French.

Imported medications also need to meet Canadian health standards, display ingredients and warnings prominently and include a drug identification number, which lets consumers know that Health Canada has approved the formulation, labelling and instructions for use.

Health Canada must soon make a decision on waiving some of these regulations to help resolve the shortage, said Justin Bates, CEO of the Ontario Pharmacists Association.

It will definitely hold up importation if there's no decision on this. Without it they can't import under the current regulations," Bates said.

I believe we will be in a precarious position throughout the winter," he added. The reality is we're in a perfect storm of COVID outbreaks, plus a backlog of surgeries and people that need pain medication. And there's a cold and flu season, which is anticipated to be severe this year."

Health Canada said in an email that it recently waived bilingual labelling rules and other requirements to increase supply of the medications and allow their importation from the U.S. and Australia, to be distributed to hospitals first.

Health Canada has recently approved the exceptional importation of ibuprofen from the U.S., and acetaminophen from Australia, to supply hospitals in Canada. Importation of ibuprofen has occurred, and distribution to hospitals is expected to begin soon. The acetaminophen product importation is expected soon," the email said.

When asked when the imported medication will be available to pharmacies for the over-the-counter purchase, Health Canada said it continues to work with manufacturers on additional proposals to import foreign product that would be made available to community pharmacies and consumers."

The department added it remained committed to bilingual product labelling.

To ensure that patients and caregivers understand what medication they are consuming, if manufacturers get foreign supply, work will be done in partnership with providers to add information in both official languages," it said.

Meanwhile, hospitals continue to struggle with a surge in young patients who have respiratory illnesses, exacerbated by the medication shortage.

Dr. Raghu Venugopal, a Toronto emergency room physician, said he has never seen such a high volume of children needing treatment for respiratory illnesses in the 20 years he has been practising. He estimates nearly a quarter of his patients currently are children.

It's a meltdown across the country. There's a massive spike in respiratory illnesses among children. The majority of their illnesses can be treated with Tylenol and ibuprofen at home for hydration and ensuring children's nasal passages and airways are clear," Venugopal said.

But when parents don't have access to these medications, they're stuck and their children end up feeling worse, so they bring them in."

The shortage has created a domino effect in pharmacies where supply of other cold and flu medications is also dwindling, said Kristen Watt, owner of Kristen's Pharmacy in Southampton, Ont.

Pharmaceutical companies have recently reported shortages of amoxicillin, an antibiotic commonly used to treat children.

In my pharmacy we're getting around 40 requests for a Tylenol or Advil a day and we're starting to be short one or two or three antibiotics a day for kids, which is going to just increase as we run out of other antibiotics," Watt said.

Bates said supply is improving slightly but demand continues to outpace it.

When asked whether production of children's Tylenol decreased during the pandemic and if production has since picked up again, the pharmaceutical company Johnson & Johnson Inc. did not comment.

Anthony Fuchs, a spokesperson for Food, Health & Consumer Products of Canada, a national trade association that includes Johnson & Johnson, also did not comment on questions about production levels and why there is a shortage in Canada but not in the U.S.

I am not in a position to answer specific questions pertaining to individual member company operations or practices," Fuchs said.

Ghada Alsharif is a Toronto-based staff reporter for the Star. Reach Ghada via email: galsharif@torstar.ca