Canada, Winnipeg: Health Canada is bracing for a drug shortage even as the department assures Canadians there is no evidence lucrative Internet pharmacies have created one, documents suggest. 

In briefing notes prepared for federal Health Minister Pierre Pettigrew, department officials also warn of "likely implications for Canada's health-care system should there be no intervention to prevent/restrict cross-border drug sales." 

Those consequences include pressure on Canada to "reduce price differentials" by raising federally controlled drug prices to come closer to substantially higher prices in the United States. 

But the documents, obtained by The Canadian Press under the Access to Information Act, also indicate the government expects pressure to mount by degrees and has a plan to monitor drug supply and act quickly if needed. 

Preparations include "a mock trial of steps to follow should a drug shortage be identified, and scenario options to reduce the shortage." 

The status of Canada's drug supply has been the focus of intensifying debate over the cross-border Internet pharmacy trade. In just four years, the industry has grown to serve about one million uninsured and underinsured Americans for an annual trade of about $1 billion US. 

Canadian opponents - including doctors, pharmacists and their regulatory bodies, as well as numerous patient advocacy groups - say there is already anecdotal evidence of supply problems. 

They want Ottawa to regulate or ban the industry to prevent widespread shortages and ensure patients have timely access to new drugs. 

The Canadian International Pharmacy Association says it has a Canada-first policy and a vested business interest in making sure mail-order pharmacies doesn't drain the Canadian supply. 

Jim Anderson, a senior policy adviser with Health Canada, said the government won't move to shut down the industry based on anecdotes alone. He also said complaints to date can't be directly linked to Internet pharmacies. 

He suggested the government has to be prepared for anything because of the growing demand for affordable prescription drugs in the U.S., as well as signs the Bush administration and Congress might eventually legalize importation in some form. 

"I think it's prudent for us to look at all the scenarios, to look at all the pressures, to consider how we would deal with the worst possible scenario," Anderson said in an interview from Ottawa. 

"Of course, it's also typically the least likely." 

But waiting for a crisis before coming up with a plan is too late, he added. 
Anderson refused to discuss Health Canada's contingency plans in detail, but said the department's strategy would depend on the nature of any shortage. 
Savings for Americans can range from 30 to 80 per cent, in large part because Canadian prices for patented medicine are federally controlled and increases are tied to the inflation rate. 

In 2003, for example, companies were allowed increases ranging from 2.8 per cent to 4.2 per cent. 

While industry critics argue drug manufacturers ultimately want Canada to eliminate price controls, the government has not felt any such pressure, Anderson said. 

"We are definitely not going to see our drug-pricing system changed to deal with this. That's not even an option." 

The president of the Coalition for Manitoba Pharmacy, a group of retail pharmacists opposed to online trade, said he's frustrated the government doesn't share his definition of a shortage. 

"It's a reality," said Lothar Dueck, who owns a family-run business in the small community of Vita, Man. 

"We don't have dead bodies on the street, but it's because of the diligence of pharmacists making sure people get their drugs." 

He has often had to send customers away with only half their prescription, or scramble to get enough stock from other pharmacists, he said. 

Concerns about shortages have been heightened in recent months after several big drug manufacturers blacklisted not only Internet pharmacies but, in some cases, anyone who supplied them. 

While the move has left online pharmacies struggling to find supplies, the Winnipeg-based Canadian International Pharmacy Association says it has its own contingency plan so Canadians aren't caught in the crossfire. 

"The moment a Canadian shortage is caused we will try to make sure any product we have will go to Canadians to try to show the Canadian government we are part of the solution, not part of the problem," said executive director David MacKay.