The Line's Nice List: Letting pharmacists do all they can to keep us healthy

It’s hard to see how this isn’t a win for overburdened health-care systems — and exhausted patients.

We at The Line are, we admit, often a bit on the grumpy side. But there are wonderful, happy stories worth celebrating, and in the final week before Christmas, we’re going to make a point of lauding some of what’s good in the world right now. That’s right: this is our nice list.

Today: Steve Lafleur on a small change that might help stabilize our struggling health-care systems.

By: Steve Lafleur

If you’ve had to deal with the health-care system lately, you’ve probably realized that things aren’t great. The health-care system was badly stretched by COVID, and now that we’re hopefully through the worst of it we’re suffering through a far less deadly but also taxing “tripledemic” of COVID, the flu, and RSV (which I can assure you, is not fun). 

Criticizing Canadian health-care has always been a bit taboo. But things have gotten so bad that everyone seems to recognize that something isn’t right. We can argue about the extent to which this is the expected outcome of a pandemic going on its fourth calendar year, and to what extent the pandemic has just laid bare weaknesses of the Canadian health-care system. Or maybe you think another firehose of federal cash will douse the flames. I’m glad we’re finally at a place where substantive discussions about the future of the health-care system may be possible. But that’s well beyond my ambition. Instead, I’d like to call your attention to a small policy tweak in B.C. and Ontario that will take some pressure off the systems. 

Getting a prescription in Ontario can be annoying. Especially in an over-burdened health-care system. It took me weeks recently to get a prescription for something relatively banal. One thing that made it a bit easier is the expansion of virtual health-care options necessitated by the pandemic. I was eventually able to talk to a doctor by phone, which lead to an in-person visit to get referred to a specialist. A few days later I queued up for a few hours to get into a “rapid access clinic.” If this doesn’t seem like a best-case scenario, it shouldn’t. 

One bronze-lining from COVID is that it forced us to re-think some nonsensical policies meant to protect us from ourselves. For instance, when we were all stuck at home Queen’s Park realized we’d probably all go insane without alcohol. So the province allowed restaurants to deliver alcohol to people’s homes, including through delivery apps. You can now get a cocktail delivered to your door in Ontario. And the world hasn’t ended (if it does before time of publication, it probably won’t be because of the gin and tonic I just ordered).

The expansion of virtual health care is another example. Now that we’re all walking around with supercomputers in our pockets, the idea of having to go to a physical office to get a prescription for a minor ailment before going to a pharmacy sounds silly. Especially for prescription refills. Why not just cut out the middle-man?  For at least some cases, that’s precisely what the B.C. and Ontario governments are doing, joining the other eight provinces that already allow pharmacists to issue prescriptions for minor ailments.

I have no medical training, so I don’t have a strong basis for determining what people should and should not require prescriptions for. But I’m skeptical that a woman needs to see a GP to get a birth control prescription in most cases, for instance. Incidentally, B.C. pharmacists will now be able to prescribe contraception. Besides, pharmacists know their drugs. 

The Ontario government is also going to allow pharmacists to prescribe some medications. It won’t go as far as British Columbia in some key respects (for instance, contraception, which pharmacists in four provinces can already prescribe to varying degrees). But it’s a step forward, even if Ontario will remain behind other provinces like Alberta.

While these tweaks may appear small, they could have a big impact. One study in the Canadian Pharmacists Journal estimated that over a third of avoidable emergency department visits in Ontario could be managed by pharmacists. While it’s just one study, that’s a big number. Especially with ER visits costing about $300 on average, according to a study by the Canadian Institute for Health Information.

Requiring patients to get a prescription from a GP or specialist also adds frictions. Like having to track down your doctor or get referred to a specialist, who you might have to go see during a weekday. At a minimum, that can be unduly time consuming and irritating. It also might lead some people to just let problems fester. In some cases, those frictions may be justified. For instance, we probably don’t want pharmacies to be too loose with opioids. But there’s a big difference between opioids and medications for pinkeye or dermatitis. 

I can’t tell you whether a GP or a pharmacist is the optimal person to give advice on medications (I won’t go full Larry David and side with pharmacists over doctors). But we don’t live in a perfect world. You don’t always get to talk to your GP on the spot. Pharmacists, on the other hand, are very accessible. And I’m reasonably confident in the pharmaceutical knowledge of pharmacists. 

Helping some people avoid having to get a prescription before going to the pharmacy isn’t revolutionary. But it’s hard to see how this isn’t a win for overburdened health-care systems — and exhausted patients.

What the B.C. and Ontario governments are offering isn’t a panacea. But it is an incremental improvement. It may be a small win, but we could use a few of those right about now.

Steve Lafleur is a senior policy analyst with a decade of experience working for Canadian think-tanks.

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