- Emergency department drug shortages are on the rise, increasing by 435 percent between 2008 and 2014.i
- Not having the most effective drugs to treat high acuity conditions can be especially serious for emergency patients.
- Ninety percent of hospitals experienced drug shortages in the last half of 2010, and 80 percent said the shortages had resulted in a delay or cancellation of a patient intervention.ii
- Emergency physicians are dedicated specialists who mobilize resources to diagnose and treat every kind of medical emergency.
How serious is the drug shortage problem in the United States?
Drug shortages impacting emergency care have grown dramatically since 2008.iii The majority of shortages are for drugs used for lifesaving interventions or high-acuity conditions. For some, no substitute is available.iv Nine in 10 anesthesiologists reported experiencing a shortage of at least one anesthesia drug, according to a survey conducted by the American Hospital Association.v Two-thirds of hospitals surveyed had experienced a shortage of cancer drugs, 88 percent were short on pain medications and 95 percent experienced a shortage of anesthesia drugs for surgery.vi The American Hospital Association found that nearly all community hospitals it surveyed experienced a drug shortage recently with nearly half having a shortage of more than 20 drugs.
What’s causing the drug shortage problem?
The immediate cause of drug shortages can generally be traced to a manufacturer halting or slowing production to address quality problems, triggering a supply disruption. Other manufacturers have a limited ability to respond to supply disruptions due to constrained manufacturing capacity, according to the GAO.
While shortages have persisted, FDA has prevented more potential shortages in the last 2 years by improving its responsiveness.
How are emergency physicians affected by the drug shortage problem in the United States?
Emergency physicians are not immune from the shortages. They witness firsthand the consequences for patients that can result from these drug shortages. In emergency departments, the shortages are a significant problem that has a lot of potential downside. The prevalence of emergency medicine drug shortages fell from 2002 to 2007; however, between January 2008 and March 2014, the number of emergency medicine drug shortages sharply increased by 435 percent from 23 to 123. From January 2008 to March 2014 shortages in drugs used as a direct lifesaving intervention or for high-acuity conditions increased 393 percent from 14 to 69, and shortages for drugs with no available substitute grew 125 percent from four to nine. Almost half (46.6 percent) of all emergency medicine drug shortages were caused by unknown reasons (the manufacturer did not cite a specific reason when contacted). Infectious disease drugs were the most common emergency medicine drugs on shortage, with 148 drug shortages totaling 2,213 months during the study period.vii
Among other medications, the short-acting sedative propofol has been difficult to get since a shortage began in 2009. Emergency physicians are also facing shortages of succinylcholine, which is used in rapid sequence intubation. Physicians worry that some may be forced to switch to less effective drugs that have different side effects and durations of action. Ten of the most basic medicines have combined for over 50 shortages in the past decade: dextrose, diazepam, epinephrine, fentanyl, lorazepam, morphine, ondansetron, nalbuphine, naloxone, and promethazine.viii There is also an ongoing shortage of normal saline solution, even though salt is one of the most abundant compounds on earth. This drug is essential for administering fluids to patients.ix
What are policymakers doing to address the national drug shortage problem?
The American College of Emergency Physicians (ACEP) cares deeply about supporting emergency physicians and their patients. ACEP commends Congress for passing legislation (S. 3187 — http://thomas.loc.gov/cgi-bin/bdquery/z?d112:SN03187:@@@L&summ2=m& ). Under this new law, the Food and Drug Administration (FDA) requires drug shortages to be reported to the FDA with at least 6 months notification. Specifically, the reporting requirement applies to drugs intended for use in the prevention or treatment of a debilitating disease or condition, including any such drug used in emergency medical care during surgery.
This law gives the FDA the much-needed authority to require drug manufacturers to report any discontinuance, interruption or other adjustment that would likely result in a shortage, especially those drugs needed to provide emergency care. Obtaining this information in a timely manner will allow the FDA to work with other manufacturers to produce the drug or reallocate resources to ensure the right drug is in the right community at the right time.
[ii] “Survey reveals 90 Percent of Anesthesiologists Experiencing Drug Shortages of Anesthetics,” Press Release, American Society of Anesthesiologists, May 9, 2011. http://www.asahq.org/For-the-Public-and-Media/Press-Room/ASA-News/Survey-Reveals-90-Percent-of-Anesthesiologists-Experiencing-Drug-Shortages-of-Anesthetics.aspx.
[vi] U.S. National Library of Medicine, NIH, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278171/
[viii] ACEP Now, March 2016, “Emergency Physicians Encouraged to Draw Attention to Pharmaceutical Drug Shortages, http://www.acepnow.com/article/emergency-physicians-encouraged-to-draw-attention-to-pharmaceutical-drug-shortages/