Pediatric Drug Shortage Led to Dosing Errors in Ontario Children , Research Shows

Empty shelves of children's pain relief medicine are seen at a Toronto pharmacy, Aug. 17, 2022. The Canadian Press/Joe O'Connal

The shortage of pediatric medication in Canada last year led to a spike of dosing errors in children in Ontario, new research shows.

The study, published Wednesday in the New England Journal of Medicine, examined the effect of the shortage of children’s ibuprofen and acetaminophen, which forced parents to crush up pills of the drugs intended for adults in order to treat their children.

Researchers found a twofold increase in calls to the Ontario Poison Centre for unintentional dosing errors of the medications for patients 18 years old or younger last fall, particularly in November 2022, compared to the four years prior.

“What our research does is shine some light on the issue of drug shortages and the potential consequences associated with them,” said Dr. Jonathan Zipursky, the lead author of the study and a clinical pharmacologist and toxicologist at Sunnybrook Health Sciences Centre in Toronto.

“Fortunately, our findings didn’t show that there was excess harm to children.”

The team also used modelling techniques to project the expected number of calls while accounting for temporal trends and a surge in respiratory illnesses in children.

Last fall, hospitals across the country were overwhelmed with really sick children as a particularly virulent strain of influenza circulated alongside respiratory syncytial virus, or RSV. COVID-19 further complicated matters for children.

The surge forced children’s hospitals in Toronto, Ottawa, Hamilton and London, Ont., to cancel surgeries in order to free up staff and beds to deal with the problem.

Hospital officials said the lack of children’s medication had a profound effect on its emergency departments. Doctors said they would often show parents how to cut up pills meant for adults.

“Children weren’t coming into hospital more often for these drug dosing errors, but that doesn’t mean no harm was done,” Zipursky said.

Parents lived with high levels of anxiety over their children’s health and many children went without treatment for fevers, he added.

By January, the shortage abated after the federal government imported nearly two million units of ibuprofen and acetaminophen.

Zipursky said he got the idea for the study because he found himself in a similar situation as others with two young children.

“We were blindsided by the drug shortage and we found ourselves as parents looking for drugs from other places or trying to follow guidance to divide pills that were intended for adults,” he said.

Zipursky and researchers from Public Health Ontario, Health Canada, the Hospital for Sick Children, the Ontario Poison Centre, St. Michael’s Hospital and Sinai Health contributed to the study.

He said drug shortages remain a concern.

“I hope we don’t find ourselves in this situation again, although I’m not that optimistic,” he said.

Dividing up adult pills to try to treat children shows how desperate parents became.

“If anybody ever finds themselves in a situation where they’re dividing a dose for a child and they’re unsure what they’re doing, they need to speak to a pharmacist or speak to a health care professional,” Zipursky said.