When our children are sick, we count on medicines provided by pharmacies and hospitals to make them better. 

Access to reliable medicines was critical amidst a shortage of children’s pain and fever medication across Canada in late 2022 and early 2023. 

In response to the shortage, Premier Danielle Smith and former Health Minister Jason Copping proudly announced plans to bring five million bottles of children’s medicines to the province. 

The Smith government quickly penned an $80 million deal with Turkey-based Atabay Pharmaceuticals in December 2022. 

The deal involved importing five million bottles of Parol and Pedifen medication.

Parol is an acetaminophen medication used to treat pain and fever in infants. 

Pedifen is an ibuprofen-based medication similarly used to treat pain, fever, and inflammation in children.  

The deal was music to the ears of parents struggling to protect their children from influenza, respiratory syncytial virus, and COVID-19.

Things Go South Quickly

The government’s good news deal with Atabay quickly turned sour. 

First, the UCP government faced delays in obtaining regulatory approval for the medicines.

After sorting out the medicines’ packaging and warning label requirements, the first shipment of 1.5 million bottles touched down in the province in spring 2023. 

By that time, the shortage of children’s medicines was already over. 

To make matters worse, fewer than 14,000 bottles were ever distributed to hospitals or pharmacies. 

There were a few reasons for this. 

Weaker Doses

Shortly after the first shipment arrived, benefits provider Alberta Blue Cross issued a warning bulletin.

The bulletin warned pharmacy service providers that Atabay products have a weaker concentration than those found in domestic medicines.

For example, Parol is roughly 75 percent the strength of medicines normally stocked in Canadian pharmacies. 

Extra Hurdles

The weaker strength meant pharmacists were asked to keep the products behind the counter and provide counselling and education to parents and caregivers on the safe and correct use of the product.

Keeping the products behind the counter made obtaining the medicine a complicated process for parents.

Speaking of complications, Isaac Van Dyne, an executive associate with Alberta Health Services (AHS), revealed in an email that the AHS Reporting and Learning system received several submissions.

The AHS Reporting and Learning system is an online portal that lets healthcare practitioners report adverse events, potential hazards, and close calls related to medicines. 

Dyne claims there were several reports of look-alike mix-ups because the Atabay Parol and Pedifen bottles look similar, creating a risk of medication errors. 

It Gets Worse. 

Submissions from the Alberta Children’s Hospital said children were gagging and refusing to take the Pedifen medication.

It’s hard enough getting children to take their medicine, but Pedifen was especially difficult for children to stomach because it is more bitter than North American medicines.

Children were also required to take a higher dosage of the medicine due to the products’ weaker concentration compounding the problem. 

Lives On The Line

Documents obtained by the Globe and Mail reveal that Atabay Parol increased the risk of a life-threatening illness in newborn patients. 

The documents show that the medicine was thicker than products usually used by AHS and sometimes clogged feeding tubes used to deliver medication to infants who can’t take drugs orally.

To unclog the tubes, nurses had to use water to flush the medicine through, which is “not ideal,” according to Dyne.

The higher volume of liquid increases the risk of a complication called necrotizing enterocolitis, a life-threatening illness that inflames the intestines of infants. 

“Neonatal patients with very low body weight have fragile and incompletely developed intestines, which cannot accommodate large boluses of fluid administration for medications,” said Dyne in an email. 

The illness has a mortality rate as high as 50 percent. 

Thankfully, the use of Parol in neonatal intensive care units was banned last spring.

The product was only used for two months before the AHS ordered its staff to stop using Atabay products and switch back to their regularly used medicines. 

According to AHS, no patients requiring neonatal intensive care were injured or fell ill after receiving treatment with Parol.

What Happens to All That Medicine? 

A crisis was avoided, but the Smith government’s latest medical fumble raises several questions. 

What will happen to the province’s stock of unused Atabay products?

Alberta’s stock of Parol will expire in November 2025 and Pedifen in January 2026. 

Last fall, Health Minister Adriana LaGrange said Parol and Pedifen would be reserved for emergencies. 

But how many concerned parents would want their children to receive emergency treatment with Atabay products? 

Our guess is not many. 

In a statement, LaGrange said the province bought the Atabay medicines with the best intentions. 

“We acted out of compassion and concern at a time when you could not find children’s medication on the shelves,” wrote LaGrange.

But for a government dismantling the health care system, we’d hope they did better research before wasting our money. 

The Fine Print

The details of the Smith government’s contract with Atabay show that our “best interest” may have been an afterthought.

Scott Johnston, press secretary to Copping, wrote in a statement that Alberta was required to purchase a minimum amount from Atabay to get the “best possible price.”

Ironically, the suggested retail price for Atabay Parol is $11.99, but Alberta paid $14 per bottle. What a steal!

With 70 percent of the order yet to be filled, the Health Ministry and AHS are exploring other options to fulfill the province’s contract with Atabay.

One of these options included reselling the imported medicine to other provinces. Unsurprisingly, there weren’t any provinces jumping at the opportunity. 

Why would they? 

The children’s medicine shortage is over, and Canadian pediatric medicine manufacturers put in the work to bolster supplies. 

“Manufacturers are producing at record rates, while Health Canada continues to provide access to imported foreign authorized products,” said Dale Hunter, a spokesperson for the Saskatchewan Health Ministry. 

The Smith government has since scrapped the idea of reselling its supply of Atabay products to other provinces. 

The remainder of Alberta’s contract with Atabay costs about $50 million. 

To pay off the rest of the contract, the government is considering the purchase of Atabay’s intravenous version of Parol instead.

It could take up to 12 months before Health Canada approves the substitute product. 

Not to mention, there is no shortage of intravenous acetaminophen in Canada, let alone Alberta. 

Smith promised us a solution to the children’s medicine shortage. The products showed up too little, too late and put our children’s lives at risk.

No matter how you look at it, the Smith government’s deal with Atabay was a costly and potentially life-threatening mistake.

That’s hard medicine to swallow.

There’s a time and a place to look for a bargain, like at a thrift store. Neither children’s medicine nor the health care system is one of them.