The shortage of life-saving EpiPens across Canada this summer has hit home – in a frightening and very real way – for a Trail woman.
Laura Livingston was loading groceries into her car at Waneta Plaza Friday morning when she felt a sudden and excruciating pain between her legs.
“A hornet flew up my skirt and stung me on the upper left thigh and it immediately swelled up into the size of a grapefruit,” she told the Trail Times. “And it was just the worst pain I ever felt from an insect, like a burning ember.”
Not grasping the severity of what was happening, she pulled the stinger out and after a brief rest inside the mall, Laura hopped into her car to drive home to Annable.
She stopped at a pharmacy in Trail because her mouth was tingly and itchy, bought some Benadryl and took half a tab, then continued on her way.
By the time Laura got home her left side was broken out in a rash, she was itchy all over, and it was getting difficult for her to swallow.
Laura was experiencing a serious allergic reaction – called an anaphylactic reaction – to the hornet sting.
“So I rushed myself to emergency,” she recalled. “And by the time I got here I could hardly breathe.”
The medical team at Kootenay Boundary Regional Hospital immediately whisked her into triage for treatment that included epinephrine (adrenaline) injections, fluids, and several hours of close observation.
“I’ve never had such a strong reaction ever before,” she said. “And I soon found out when I got to emergency that it was not my throat that was closing up, it was the lower trachea closer to the stomach. Who knew this was a life threatening situation? Certainly not me.”
Her discharge later that afternoon included a prescription for two EpiPens. The doctor warned her the next sting would likely be even more severe and possibly lethal.
This condition is called anaphylactic shock.
Epinephrine, the medication used to treat anaphylaxis, is readily injectable by the EpiPen.
A quick self-injection would save her life in the event of anaphylactic shock, therefore the drug must be kept with her at all times.
So imagine Laura’s surprise when she found out that not one pharmacy in Trail had an EpiPen in stock, much like pharmacies across the country.
Pharmacist Linda Seib, from Shoppers Drug Mart in Trail, says her store’s supply was depleted earlier this month.
And there is no certainty of when Epipens will be available again.
“Pfizer Canada, the company that makes EpiPens, advised Health Canada in January of this year that supply of EpiPens would be limited,” Seib explained.
“In April, Pfizer was managing the national supply through measured allocation to wholesalers where pharmacies order from. Our supply was depleted the beginning of August.”
Pfizer Canada has not given a specific availability date, she added.
“They do not expect to be able to provide new supply until the end of August or possibly longer.”
Fortunately, Trail Shoppers Drug Mart could help Laura out by providing a vial of epinephrine (one dose only) and a make-shift injection kit in case she gets stung again.
Laura says this was the only local pharmacy that had a vial of the lifesaving medication on hand. And that worries her after going through what she did.
“I’ve been laying horizontal since Friday because I felt like I had the flu and I was nauseous, not to mention the excruciating pain.”
Now that she knows what to expect the next time, Laura worries about self-treatment.
First she would have to fumble with the epinephrine vial to open it, unpackage and fit the needle parts together, then draw the medication to 0.3 mg and make sure there are no bubbles – all before injecting herself into the thigh.
“Because I went through it, I know your motor skills slow down,” Laura said, mentioning she lives alone. “I was dizzy and confused, probably because I was short of oxygen. So this manual injection worries me because of the time it takes to load.”
There are currently no alternative auto-injectors available on the market in Canada.
“This is such a travesty for them to run out of a life saving medication,” Laura said. “Don’t get me wrong, I am grateful to have the vial of epinephrine, but (without EpiPens in stock) it’s a basic drug that should be in every pharmacy.”
Seib says her store keeps epinephrine ampules on hand because they offer injection services. If someone has an allergic reaction after an injection from the pharmacy, the drug must be readily available.
In January, Health Canada issued an advisory about the shortage of EpiPen auto-injectors and stated the shortage is “reported to be due to a manufacturing disruption that was anticipated to be resolved by March 2.”
Then on July 30, Health Canada issued a warning that “Pfizer continues to experience supply shortages of EpiPen® epinephrine auto-injectors in the 0.3 mg and 0.15 mg doses.”