Arthritis drug shortages push Canadians to ration and stockpile medication

Patients with arthritis in Canada are rationing doses, stockpiling refills and calling up to fifteen pharmacies just to fill a single prescription. 

A new report from the Canadian Arthritis Patient Alliance (CAPA), Broken Chains: Drug Supply Disruptions Impact Patient Lives, uses interviews with people living with arthritis and caregivers across Ontario, Quebec, Western and Atlantic Canada to show how drug shortages disrupt treatment, work and daily life. 

Since 2017, people with arthritis have faced recurring shortages.  

The COVID‑19 pandemic intensified the problem.  

Hydroxychloroquine, used for systemic lupus erythematosus and rheumatoid arthritis, became scarce after speculation it could treat COVID‑19.  

Later, tocilizumab (Actemra), another inflammatory arthritis drug, was shown to benefit people with severe COVID‑19, pushing many to switch from infusions to self‑injectable forms to maintain access. 

Shortages now cut across drug classes. Interviews highlighted gaps in supply for: 

• Analgesics and pain medications such as Percocet, Tylenol 3 and hydromorphone  

• DMARDs including methotrexate, sulfasalazine, leflunomide and hydroxychloroquine  

• Biologics and biosimilars such as etanercept (Enbrel) and abatacept (Orencia)  

• Adjunct therapies such as cholestyramine and JAK inhibitors, plus over‑the‑counter products like muscle relaxants and acetaminophen 

In severe cases, Health Canada has allowed importation of medicines, including abatacept in 2024, to stabilise supply. 

Many patients only learn about a shortage at the pharmacy counter or when a home delivery fails or arrives at the wrong temperature and spoils.  

The report links these moments to anxiety, helplessness and cascading impacts on work, sleep, mental health, mobility, independence and vaccination schedules.  

Caregivers feel the strain as well. 

Fear of going without has changed how people manage their own medication. Some create personal stockpiles; others skip or stretch doses “just in case.”  

They describe the long, fragile process of finding a combination that works and the sense that this precarious stability is at risk every time a shortage hits. 

Support from healthcare providers varies.  

Some prescribers identify alternatives quickly and stay involved. Others leave patients to navigate pharmacies, substitutions and insurance on their own.  

One person who contacted a rheumatologist’s office during a shortage recalled being told, “Well what do you want me to do?” and said no options for other medications were offered. 

Switching is not always possible or safe.  

Contraindications, allergies and limited alternatives mean some patients cannot simply move to another drug.  

During recent opioid shortages, some were forced into a new trial‑and‑error process; others tapered off opioids entirely because no suitable option was available. 

Several participants reported stigma when trying to fill opioid prescriptions. Calling multiple pharmacies for medication led to suspicion or added scrutiny, even for people with years of appropriate use. 

Communication around shortages is typically reactive.  

Patients say they rely on social media, traditional media and peers because tools such as the Drug Shortages Canada website are poorly publicised, underused and subject to fluctuating dates.  

One person in a rural area travelled 30 minutes to a pharmacy only to learn on arrival that their medication was unavailable.  

Many said they would rather receive early warnings about potential shortages than be surprised at refill time. 

There is also no standard way for people with arthritis to report the shortages they experience. 

Existing systems focus on manufacturers and distributors, even though patients bear the direct health, mobility and mental‑health impacts.  

Some suggested a green‑yellow‑red traffic‑light system to signal supply status and expected duration. 

The report notes that shortages intersect with other policies such as opioid tapering mandates and biosimilar switching rules, along with strict 30‑day dispensing limits and lengthy prior authorisations. 

One person insured under Blue Cross said that, despite chronic rheumatoid arthritis and fibromyalgia, they could not access more than a 30‑day supply of critical medications, while some insurers allow up to a three‑month supply for maintenance drugs.  

Patients described stress, guilt and undisclosed rationing driven by these constraints. 

Interviewees want clear resources that explain why shortages occur, how to maintain a sufficient supply, what alternatives exist, how to advocate with pharmacies and prescribers, and what insurance issues to expect.  

People taking immunosuppressants said they sometimes use planned pauses for infections or vaccines to build a small buffer for peace of mind. 

To respond, CAPA recommends: 

• Proactive communication protocols so pharmacies and prescribers alert patients early via phone, SMS, email or apps, including in rural and remote areas  

• Patient‑centred risk management that avoids stigma, recognises when switching is not appropriate and plans for essential medicines in rheumatic and related diseases  

• Greater flexibility from drug plans and insurers during shortages, including temporary coverage for alternatives and streamlined authorisations  

• A central patient portal building on Health Canada’s “Building Resilience” plan, with real‑time supply status, coping strategies, alternative options and links to Drug Shortages Canada  

• A patient‑facing reporting tool integrated with Drug Shortages Canada and expanded engagement of patient partners and groups in the Multi‑Stakeholder Steering Committee (MSSC) 

Mina Tadrous, a scientist and pharmaceutical policy expert at the Leslie Dan Faculty of Pharmacy at the University of Toronto, said drug shortages “are not just supply chain problems” but also show “where [the health system] falls short.”  

He said incorporating patient experience can guide responses, policies and research. 

“Drug shortages are not minor inconveniences for people managing chronic conditions,” said Linda Wilhelm, president of CAPA. She said when long‑established treatment plans are disrupted, the effects extend to people’s health, work and daily lives.