Drug Shortages in EDs Have Increased More Than 400%

More than half of shortages involved life-saving drugs

Emergency departments (EDs) are health care’s front line — in the U.S., nearly 45 out of 100 people visit an ED in any given year. But there is an issue brewing behind the scenes in emergency medical facilities, one that can’t be fixed by a simple stitch or bandage, according to an article in the Washington Post. A new study published in Academic Emergency Medicine has shown that drug shortages in EDs across the U.S. increased by more than 400% between 2001 and 2014.

The study analyzed data from the University of Utah Drug Information Service, which receives drug-shortage reports submitted through a public site administered by the American Society of Health-System Pharmacists. Two practicing ED physicians assessed whether the reported shortages had to do with drugs used in EDs, and then looked at whether they were associated with lifesaving or acute conditions.

Of the nearly 1,800 shortages reported between 2001 and 2014, nearly 34% were for drugs used in EDs. More than half (53%) of all reported shortages were of lifesaving drugs, and 10% of shortages affected drugs with no substitute. The most common drugs in short supply are used to treat infectious diseases, to relieve pain, and to treat patients who have been poisoned. Although the number of shortages fell between 2002 and 2007, it rose by 435% between 2008 and 2014.

That’s nothing less than a public health crisis, senior author Jesse Pines, of the George Washington University School of Medicine & Health Sciences, told the Washington Post. Shortages “are real, they’re happening, and they’re getting worse,” he said.

The primary reasons given for shortages were manufacturing delays (26%), supply and demand (15%), and the availability of raw materials (4%). Pharmaceutical companies listed “business decisions” as the reason for a shortage 2.1% of the time. In more than 46% of the shortages studied, no reasons were given.

Pharmaceutical Research and Manufacturers of America (PhRMA), an industry group, points the finger at secondary wholesalers. “The manufacturer of a drug has no influence or control over the prices charged by a secondary wholesaler to a hospital or pharmacy,” the group said in a statement. Supply-chain issues and shortages of raw materials shortage can also play a part in shortages.

Although the FDA has issued a long-term strategic plan to prevent drug shortages, the agency admitted that it cannot require pharmaceutical companies to make certain drugs, to produce more of a drug, or to change the amount distributed. 

Ironically, increased FDA oversight might even create more shortages, the Post article says. Researchers have noted that rather than invest in infrastructure or submit to enhanced inspections, businesses may decide simply to stop producing drugs. “This is one of the byproducts of a focus on cost in health care,” Pines explained. “There may be a demand for a medication, but it may not be in a company’s best interest to produce it because the amount they can charge is often lower than the amount it costs to manufacture it.”

Source: Washington Post; January 22, 2016.