A nationwide shortage of the abortion pill is expected next week — just months after previous shortages of the drug forced some patients to have surgical abortions instead.
“When our hands are tied, it’s really frustrating not to be able to provide the standard of care,” said Dr. Emily Stuart, an abortion provider on Vancouver Island.
The abortion pill, known as Mifegymiso, first became available in Canada in 2017 as an alternative to surgical abortion.
It has greatly expanded access to abortion because the drug can be prescribed by a family doctor and made available by a pharmacy up to 10 weeks into a pregnancy. Mifegymiso is not the same as the so-called Plan B or the morning-after pill, an emergency contraceptive taken within 72 hours of intercourse to prevent pregnancy.
“Abortion is time sensitive … if you have to wait two weeks, you could be out the window.” – dr Emily Stuart, abortion provider on Vancouver Island
Linepharma, the only supplier of the abortion pill in Canada, blames delivery delays, production restrictions and shortages of the active ingredients used to manufacture the drug.
The shortage is expected to begin on February 20 and last two weeks through March 6.
“Abortion is timely,” Stuart said. “If you have to wait two weeks, you could be out the window.”
A surgical termination of pregnancy can be performed later in a pregnancy, but requires an in-person visit to a hospital or abortion clinic. People who want surgical abortions may have to travel from smaller communities where the service is not available.
Some patients also prefer the abortion pill because it can be taken at home and is less invasive than surgery.
Abortion providers across Canada are telling CBC News they are stockpiling their own supplies of mifegymiso and plan to share it with others.
“Some pharmacies have a limited supply of mifegymiso, but not a very high supply,” said Patricia LaRue, who runs the Clinique des femmes de l’Outaouais, an abortion provider in Gatineau, Que.
“So we’re afraid some people might not have access to the products.”
Health Canada told CBC News that it has been in contact with the drug’s manufacturer and has been told “that the deficiency is not expected to affect the availability of mifegymiso at the patient level.” The department said it is speaking to the company to ensure a continued supply of mifegymiso.
Second shortage since December
This is the second mifegymiso shortage to hit Canada in the last three months.
Linepharma previously reported a shortage that lasted four weeks from November 23 to December 20. The company blamed delivery delays. Abortion providers said they received little notification.
Stuart said that during the last shortage she had to ask some patients who wanted the abortion pill if they would accept surgery.
Waiting lists for surgical abortions grew longer during the mifegymiso shortage, Dr. Renee Hall offering abortions in Vancouver.
She said some clinics are able to offer an alternative form of drug-induced abortion, although it’s not ideal.
“The problem is that it’s less effective, has more side effects, and lasts a lot longer,” Hall said.
In some cases, Hall says, alternative drug therapy hasn’t worked and the patient has ultimately required surgical abortion.
“In situations like this, it bothers me a lot that we have to deal with the shortage,” Hall said.
The abortion pill is also used to induce miscarriage.
CLOCK | Shortage of abortion pill expected in Canada:
In Regina, a group of volunteers transported abortion pills to patients in rural and remote areas after pharmacies in smaller communities ran out.
“It just drastically reduced the opportunities for abortion,” said Julian Wotherspoon of the Regina Abortion Support Network.
“In Saskatchewan, we really have so many roadblocks before we even get to this recipe that the shortage was just another thing.”
Most pharmacies keep limited supplies
The supply problems have highlighted the importance of the abortion pill across the country, said Kelly Bowden of the Action Canada for Sexual Health and Rights group. The national charity works to improve access to abortion and offers a support hotline for people looking for abortion information and providers.
While there are hundreds of surgical abortion providers in Canada, there are now thousands who can perform birth control pills, Bowden said.
But even with more doctors able to prescribe it, not all pharmacies carry the abortion pill as it is a rather expensive drug with a relatively early expiry date. Some also refuse to wear it.
“If you had more dispensaries, you would essentially have a larger stock…that would take longer to deplete stocks in the event of a shortage,” Bowden said.
Company hopes to avoid expected bottlenecks
British pharmaceutical company Linepharma, the only manufacturer authorized to offer the abortion pill in Canada, makes mifegymiso through a third-party facility in Spain, said Dana Tenenbaum, general manager of Linepharma Canada. The company ships between 50,000 and 80,000 cans a year to Canada, he said.
“It’s still a very niche product,” he said.
Tenenbaum said the shortage was partly due to a slowdown in shipments of the active pharmaceutical ingredient mifepristone, which the company sources from Europe.
“Very few places, very few companies make these types of drugs,” he said.
Tenenbaum said the company has notified Health Canada of the expected shortage based on current inventory and demand. He said the company doesn’t expect the shortage to last more than two weeks.
“We’ve been able to work with pharmacies and clinics to — it’s a lot of work — but really closely monitor every unit that goes out,” he said.
Abortion providers said Linepharma gave them a warning this time so they are working to make sure they have enough medicine on hand.
“I think the clinics are well suited for these short, small stays. It’s not ideal, but we can do it,” said Dr. hello
“As it gets longer, waiting times for surgical abortions will increase and the quality of abortions will decrease.”
