Is Your Hospital Facing a Drug Shortage?

It's every parent's nightmare: a teenager suddenly diagnosed with cancer. And when treatment has to be postponed because the hospital has run out of the appropriate chemotherapy drug, the situation can spell desperation.

This is apparently what happened at Miami Children's Hospital, where doctors were forced to postpone chemotherapy for Caroline Pallidine, according to the Washington Beacon. The 14-year-old had to wait a month for her last course of medication.

Growing Shortages

The U.S. Food and Drug Administration (FDA) tracks supply levels of approved drugs nationwide. American Medical News reports that the agency noted a record number of shortages in 2010, and the problem appears to be escalating.

The FDA began tracking supply problems in 2005, when it noted shortages among 61 drugs. By the end of 2010, the number of medications linked to supply problems had jumped to 178. The majority of drugs in short supply are primarily administered in hospitals, triggering crisis situations for some patients.

A number of factors contribute to medication supply issues. Some are linked to production and quality issues, especially when it comes to drugs administered by injection. Some pharmaceutical companies have elected not to produce certain medications or to cut their production levels because of profitability concerns. The time required to complete FDA inspections has also been cited as a cause.

While doctors are often able to substitute other medications when a shortage occurs, they must educate their patients on how to use the new drugs and what their potential side effects are. Some maintain that being forced to substitute an alternative medication is a recipe for more prescribing errors.

Drugs in Short Supply

The American Society of Health-System Pharmacists maintains a current list of drugs in short supply in the United States. The Washington Beacon cites the highly publicized shortage of a sedative used on death row. In addition, your hospital might have a shortage of these drugs:

Thiopeta. Hospitals use it with bone marrow transplants.

Electrolytes. There is a shortage of many of them. Of greatest concern are those that must be injected to tube-feed critically ill patients or premature babies.

Norepinephrine. This drug is utilized for septic shock.

Acetylcyseine. Doctors prescribe it for cystic fibrosis.

Cardiac injections. Emergency-room personnel utilize them for specific kinds of cardiac arrest.

ADHD meds. Some pills utilized for patients with attention deficit hyperactivity disorder are in short supply.

Leuprolide. Patients receive these hormone injections as part of fertility treatment.

Potential Fixes

The FDA lacks the authority to compel a pharmaceutical company to make a drug. However, the agency's efforts in 2010 prevented 38 drugs from falling into the shortage category. This involved actions such as fast-tracking the approval of manufacturing changes and alerting competitors to gear up when a drug shortfall appeared likely.

Legislation in the pipeline would require manufacturers to provide the FDA with notice of potential delays in manufacturing a drug. At least one member of Congress thinks the Federal Trade Commission (FTC) should review pending pharmaceutical mergers to determine whether they're likely to result in any drug shortages.

While some drug manufacturers insist that they're ramping up production to alleviate shortages and prevent new ones from occurring, they're quick to point out that things like FDA inspections are beyond their control. The agency has requested that certain overseas concerns temporarily ship to the U.S. their formularies of drugs considered scarce here. Among them is propofol, a major drug used in anesthesia.

In the meantime, U.S. hospitals continue to face a growing shortage of drugs to treat a variety of health problems.

Sources:

Lauran Neergaard, "Hospitals face acute shortages of drugs," Washington Beacon, July 2011, p. 4-5.

http://www.ama-assn.org/amednews/2011/08/01/prl20801.htm

http://www.ashp.org/DrugShortages/Current/