U.S. Hospitals Facing Shortage of Pain Medication
By Chaunie Brusie
When you have an emergency, you probably don’t think twice about what you need to do next: you simply head to the hospital, where the trained medical staff can take care of you, right?
But what happens when the hospitals run out of medicine?
Unprecedented drug shortages
That scary scenario is actually happening now in hospitals across the United States. As of May 2018, 9 out of 10 emergency room physicians surveyed said that they did not have access to the “critical” drugs that they needed to treat patients.
As an example of just how dire the situation is, the New York Times reported that one hospital in Chicago has been out of morphine, a drug commonly used for pain, since March. That’s a staggering almost five months without a drug that is used every single day in most hospitals for even minor cases. Also on the list of drugs that have slowly gone missing without any hope for replacement are diltiazem, a drug used in cardiac care, and painkillers. The FDA’s website has a continually-updated list of drug shortages, which currently include everything from sodium chloride injections to combination heparin and dopamine mixtures. “We now have to drain off 900ml from a 1,000ml bag in order to mix infusions. 1,000 ml NS bags are the only solution we can currently get. This is a serious problem. “One more example of #drugshortages” tweeted Dr. Jeff Jarvis, an ER physician in Texas back in January. And while drug shortages are nothing new, the sheer volume of today’s scarcities are unprecedented.
As a solution to the drug scarcity epidemic, doctors and medical care staff have been making do by either providing patients with alternative drugs, which may pose riskier side effects or cause unknown reactions or simply going without, unable to help when patients are in pain. One doctor described the scramble to figure out how to treat their patients without their long-relied upon medications as a “dancing” that occurs with every single patient and every single shift. And unfortunately, all of that dancing only leads to one thing — patients not getting the care that they need.
“This crisis is impacting patient care across the country,” said Academy of Ophthalmology President Keith Carter, M.D., FACS in a statement. “No region or demographic is spared from the harm these shortages cause.”
What’s driving the shortage?
Why are hospitals running out of critical medications that have historically been used almost every day? The answer is apparently pretty complex. For one, many of the drugs that the hospitals have come to rely on are both hard-to-make and cheaply sold, leading to low-profit margins for the drug manufacturers. With low profits, many of the drug companies simply stopped making them. Secondly, these types of drugs have long been made in older facilities which many companies have stopped investing in, leading to the factories to have problems and many to be shut down altogether. Drug manufacturing was particularly affected when Hurricane Maria hit Puerto Rico, home to a major center for pharmaceutical production and although the initial crisis has been resolved, the storm still brought the shortage to the forefront for America’s medical community.
Leading the way for much of the shortage is drug manufacturer giant Pfizer, which has been hit with warning after warning from the U.S. government. Pfizer is the nation’s single largest manufacturer of generic injectable drugs and essentially, with any slowdown in their production rate, the entire country is affected. Back in February of 2018, the FDA warned that one of the manufacturing processes at a facility in Houston was “out of control” when complaints of substances in IV solution bags turned out to be pieces of cardboard.
A call to action
The lack of medication has become so severe, in fact, that in June, the American College of Emergency Physicians (ACEP), the American Society of Anesthesiologists (ASA) and the American Academy of Ophthalmology (AAO) all issued a joint statement urging the FDA to work with federal departments in order to give recommendations to Congress on how to fix the drug shortage problem.
“These persistent shortages can last for months or longer and affect all types of medications used in a variety of settings – emergency departments, hospitals, ambulatory, surgical centers, among others,” related James Grant, MD, president of the ASA in the official statement. “These are essential products used every day, and for many, there are no suitable alternatives readily available. Critical shortages of injectable opioids and local anesthetics are affecting anesthesiology practices, public, private and academic throughout the country.”
The drug shortage is becoming a crisis in America, but unfortunately, patient care doesn’t stop while we wait for a solution. So as lawmakers and experts work to find a solution, we all have to do our part to advocate and support the nurses and other healthcare staff who are caring for patients directly each and every day — even without the medicine those patients need and deserve.