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Analysis

Drug Shortages Force Desperate Measures

By John Commins  
   July 02, 2018

The American Medical Association and other key stakeholders are calling for a coordinated effort to address a crippling nationwide shortage of drugs that include injectable opioid analgesics, IV fluids, and Epi-pens.

The nation's drug shortage has gotten so severe that hospitals are taking desperate measures to meet patients' needs, as emergency departments brace for the busy summer months.

"So many substances are short, and we're dancing every shift," James Augustine, MD, an emergency physician in Cincinnati told The New York Times.

Michael Cohen, president of the Institute for Safe Medication Practices, told AP that the shortages prompt potentially harmful medication mix-ups and workarounds when nurses or pharmacists substitute unfamiliar painkillers or ones with different concentrations.

Cohen cited reports of at least two surgical patients who had overdosed when fentanyl wasn't available and they were mistakenly given the same amount of much stronger sufentanil.

In June, the American Medical Association declared the drug shortages an "urgent public health crisis," and urged the federal government to review the issue as national security initiative.

"The fact that drug shortages worsened when major hurricanes struck drug production facilities on Puerto Rico highlights the need to evaluate and plan for hazards that pose a threat to critical infrastructure for manufacturing pharmaceutical and medical products," said AMA Board Member William E. Kobler, MD.

  • This spring, Pfizer issued an advisory to hospitals, that provided special handling instructions due to potential for cracked needle hubs and particulate in the drug maker's glass syringes.
     
  • A survey of 343 hospitals this spring by the American Society of Health-System Pharmacists found that 98% had moderate or severe shortages of morphine, fentanyl and hydromorphone, aka Dilaudid. Many hospitals were completely out of at least one. Hospitals also are grappling with shortages of local anesthetics: lidocaine, bupivacaine and a third type that is standard for eye surgery, orthopedic procedures, and knee and hip replacements.
     
  • Nine in 10 emergency physicians responding to a recent poll said that in the past month, they have experienced shortages or absences of critical medicines in their emergency departments.  "Emergency physicians are concerned that our system cannot even meet daily demands, let alone during a medical surge for a natural or man-made disaster,"  said Paul Kivela, MD, president of American College of Emergency Physicians.
     
  • Food and Drug Administration Commissioner Scott Gottlieb, MD, said drugs shortages "are an inevitable consequence of an imperfect system. With better planning, we can minimize shortages throughout the supply chain. But, in the near term, we won’t be able to fully eliminate the possibility that new shortages will arise. Meaningfully impacting the structures and market challenges that can give rise to shortages will require more coordination among public and private stakeholders."

John Commins is a senior editor at HealthLeaders.


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