A growing shortage of medications for a host of illnesses has hospitals around the country scrambling for substitutes to avoid patient harm and in some cases, even delaying treatment.
While the shortage has not affected patient care locally, both Charlevoix Area Hospital and Northern Michigan Regional Health System are watching the trend.
“We have experienced daily issues with trying to obtain specific drugs,” said Joe Hawkins, pharmacy manager at Charlevoix Area Hospital. “While there have been no trends in any particular group, we have seen significantly more shortages in the past two years than we have seen in my 20-plus years in pharmacy.”
The number of medications in short supply has tripled over the past five years, to a record 211 medications in 2010. While some of those shortages have been resolved, another 89 drug shortages have occurred in the first three months of 2011, according to the University of Utah’s Drug Information Service, which tracks shortages for the American Society of Health-System Pharmacists.
The vast majority of drug shortages involve injectable medications used mostly by medical centers — in emergency rooms, intensive care units and cancer wards. Particular shortages can last for weeks or for many months, and there aren’t always good alternatives.
Last month, doctors at Miami Children’s Hospital had to postpone the last round of chemotherapy for a 14-year-old girl for a month because of a nationwide shortage of cytarabine, a drug considered a key to curing a type of leukemia.
There are many causes for the shortages of medications, including recalls of contaminated vials, spikes in demand, trouble importing raw ingredients and factories that temporarily shut down for quality upgrades.
Also, some experts point out that pricier brand-name drugs are seldom in short supply.
The Food and Drug Administration agrees that the overreaching problem is that fewer and fewer manufacturers produce these older, cheaper generic drugs, especially the hard to make injectable ones.
That means if one company has trouble, or decides to quit making a particular drug, there are few others to increase their own production to fill the gap.
Hawkins also added that pressure is put on suppliers of certain drugs who struggle to fulfill the demand. Hawkins said a cottage industry has cropped up, known in the pharmacy business as “jobbers.”
“These companies become aware of a shortage on the horizon and step in and buy up large quantities of a given drug then inflate the cost to the point of it being prohibitive to the customer,” he said.
Administrators from both Charlevoix Area Hospital and Northern Michigan Regional Health System stress that the shortage has not affected patient care locally, but the trend is being watched closely.
“Although we are not immune to the drug shortages being felt across the nation, our patients have not experienced any interruption in their care,” said Reezie DeVet, president and CEO of Northern Michigan Regional Health System.
“The health and safety of our patients is our number one priority. Because of that, we are continually working with our anesthesiologists, oncologists and other providers, to find alternative treatment and dosage options when possible until these shortages are resolved.”
The Federal Drug Administration has asked some foreign companies to temporarily ship to the U.S. their own versions of some scarce drugs that aren’t normally sold here.
Lawmakers are also getting involved. Pending legislation would require manufacturers to give the Federal Drug Administration advance notice of problems such as manufacturing delays that might trigger a shortage.
The American Society of Health-System Pharmacists currently lists 197 drugs for which there are recent drug shortage bulletins.
— Cytarabine injection, a chemotherapy drug used to treat leukemia
— Propofol, a commonly used surgical anesthetic
— Dopamine injection, used to help patients in heart failure
— Phenytoin oral, used to control seizures
— Fentanyl injection, fentanyl transdermal system patch; used to treat chronic pain
— Black widow antivenin, used to treat bites from the black widow spider
— Lorazepam injection, used for the short-term treatment of anxiety, insomnia and acute seizures
— Measles, mumps, rubella and varicella virus vaccine live injection
For a list of drug shortages, visit www.ashp.org/drugshortages/current