Doctors brace for a nationwide shortage of abortion pills

A nationwide shortage of the abortion pill is expected next week — just months after previous shortage of the drug forced some patients to get surgical abortions instead.

"When our hands are tied, it's really frustrating to not be able to give 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 abortions.

It greatly opened up abortion access since the drug can be prescribed by a family doctor and provided by a pharmacy up to 10 weeks into a pregnancy. Mifegymiso is not the same as the so-called Plan B or "morning after" pill, which is an emergency contraception medication taken within 72 hours of sex to prevent pregnancy.

Linepharma, the sole supplier of the abortion pill in Canada, blames delivery delays, manufacturing constraints and shortages of the active ingredients used to make the drug.

It said it expects the shortage to begin Feb. 20 and last for two weeks, until March 6.

"Abortion is time-sensitive," Stuart said. "If you have to wait two weeks, you could be outside of the window."

Surgical abortion can be provided further along in a pregnancy but it requires an in-person visit to a hospital or abortion clinic. People seeking surgical abortions may have to travel from smaller communities where the service is not provided.

Some patients also prefer the abortion pill because it can be taken at home and is less invasive than the surgery.

Abortion providers across Canada tell CBC News they're stockpiling their own supplies of Mifegymiso and are planning to share them with others.

"Some pharmacies have a limited stock of Mifegymiso available but not a very high stock," said Patricia LaRue, who heads up Clinique des femmes de l'Outaouais, an abortion provider in Gatineau, Que.

"So we're scared that some people might not have access to the products."

Health Canada told CBC News it has been in contact with the drug's maker and has been told "the shortage is not expected to impact the availability of Mifegymiso at the patient level." The department said it's talking to the company to ensure a continued supply of Mifegymiso moving forward.

Second shortage since December

This is the second shortage of Mifegymiso 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 shipping delays. Abortion providers said they were given little notice.

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 got longer during the Mifegymiso shortage, said Dr. Renee Hall, who provides abortions in Vancouver.

She said some clinics were able to provide an alternative form of drug-induced abortion, although it's not ideal.

"The issue is that it is less effective, it has more side effects, and takes a lot longer," Hall said.

In some cases, Hall said, the alternative drug regimen didn't work and the patient ended up requiring a surgical abortion.

"Those kind of situations, that's when it bothers me a lot that we do have to deal with the shortage," Hall said.

The abortion pill is also used to induce someone who miscarries.

WATCH | 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 ability to access abortion," said Julian Wotherspoon of the Regina Abortion Support Network.

"In Saskatchewan, we really have so many barriers before we even get to that prescription that the shortage was just one more thing."

Most pharmacies keep limited stocks

The supply issues have demonstrated how important the abortion pill is across the country, said Kelly Bowden of the group Action Canada for Sexual Health and Rights. The national charity advocates for better abortion access and provides a support line for people looking for information and abortion providers.

While there are hundreds of surgical abortion providers in Canada, there are now thousands who can provide abortion using the pill, Bowden said.

But even with more doctors able to prescribe it, not all pharmacies carry the abortion pill because it's a fairly expensive medication with a relatively early expiry date. Some also refuse to carry it.

"If you had more dispensing locations you would have essentially a larger stockpile … that would take a longer amount of time to dwindle down supplies in the case of a shortage," Bowden said.

Company hoping to avoid anticipated shortage

The U.K. drug company Linepharma, the only producer authorized to provide the abortion pill in Canada, manufactures Mifegymiso through a third-party facility in Spain, said Dana Tenenbaum, the general manager of Linepharma Canada. The company supplies between 50,000 and 80,000 doses per year to Canada, he said.

"It's still a very niche product," he said.

Tenenbaum said the shortage is partially due to a slowdown in supplies of the active pharmaceutical ingredient mifepristone, which the company sources from Europe.

"Very few places, very few companies, manufacture those types of drugs," he said.

Tenenbaum said the company notified Health Canada of the anticipated shortage based on current inventory and demand. He said the company doesn't expect the shortage to last more than two weeks.

"We have been able to work with pharmacies and clinics to — it's a lot of work — but to really tightly monitor every unit that's going out," he said.

Abortion providers said Linepharma gave them a warning this time, so they're working to ensure they have enough medication on hand.

"These short little stints, I think the clinics are well suited to handle. It's not ideal, but we can manage it," Dr. Hall said.

"If it gets longer, the surgical abortion wait times will get longer and the quality of the abortions go down."