When a “Drug Shortage” Isn’t Official—But Residents Still Go Without

This morning when I asked for my pain meds, I was informed that the home has suddenly been unable to receive their usual 1 mg hydromorphone tablets.

So, the question and a fair one is why? Of course I was then off to research with google and chat gpt and here is what I have learned. 

When a medication isn’t available, most people assume there must be an official drug shortage. But sometimes the reality is more complicated.

In this case, there does not appear to be a Canada-wide shortage declaration for every manufacturer of 1 mg hydromorphone tablets. Yet pharmacies across the country have reported unstable supplies and intermittent back orders. In other words, a medication can be available somewhere in Canada while still being unavailable to the pharmacy serving your long-term care home. That distinction matters.

Small Dose. Big Impact.

Hydromorphone is a powerful opioid used to manage pain. In long-term care, the 1 mg strength is often prescribed because many residents require small, carefully adjusted doses. These are not “optional” medications. They are used by residents who may be living with:

• Chronic pain
• Cancer-related pain
• Palliative or end-of-life care
• Frailty that requires very cautious dosing

When the 1 mg tablets aren’t available, physicians and pharmacists have to find alternatives. That might mean splitting higher-strength tablets (when appropriate), using a different formulation, or changing the prescription altogether.

These are safe and common practices when managed properly—but they also create additional work for physicians, pharmacists, and nursing staff. More importantly, they introduce changes for residents who were already stable on their medication.

The Challenge for Long-Term Care

Long-term care homes don’t simply order medications from whichever supplier has stock. Most homes receive medications through contracted pharmacy providers, which in turn rely on wholesalers and manufacturers. If that supply chain runs short, a home may have no immediate alternative, even if another pharmacy in another part of the province still has inventory. That’s one reason why one home may experience a shortage while another does not.

This Is About More Than One Medication

This isn’t just about hydromorphone. Over the past several years we’ve seen shortages involving antibiotics, pain medications, and other essential drugs. Every shortage creates extra work behind the scenes as health-care professionals scramble to ensure residents continue receiving safe and effective care. Residents often never see those efforts and Families may only notice that a medication has changed or wonder why something that worked well yesterday suddenly isn’t available today.

Here Are More Reasons Why Transparency Matters

 When medications become difficult to obtain, residents and families deserve honest communication. We deserve to know:

• Why the medication isn’t available.
• Whether a safe alternative has been prescribed.
• What monitoring will take place after the change.
• Whether the issue is expected to be temporary.

Good communication builds trust, especially when circumstances are outside the home’s control.

No Filters. No Excuses. Just Reality.

Not every medication shortage makes the evening news. Sometimes it’s as simple as a 1 mg tablet becoming difficult to source. But for the resident relying on that medication to control pain, there is nothing “small” about it.

The professionals in our long-term care homes will continue doing what they always do—Finding safe alternatives and adapting to the circumstances they are given. The question is whether our medication supply system should be more resilient, so residents aren’t the ones feeling the effects when the supply chain falters.

As always, we’ll continue following this issue. If you’re a resident, family member, or staff member in another long-term care home experiencing similar difficulties obtaining 1 mg hydromorphone tablets, I’d like to hear from you. The more we understand how widespread these disruptions are, the better we can advocate for lasting solutions.