SALEM, Ore. — When paramedics ran out of a critical drug used to treat irregular heartbeats, the Bend Fire Department in Central Oregon dug into its stash of expired medications, loaded the trucks, and kept treating patients.
Paramedics reported asking some of those facing medical emergencies: “Is it OK if we use this expired drug?”
Emergency responders in various jurisdictions have reported turning to last-resort practices as they struggle to deal with a shortage of drug supplies created by manufacturing delays and industry changes. Some are injecting expired medications or substituting alternatives. Others are simply going without.
As the drug crisis mounted for the Bend Fire Department earlier this year, the agency had 11 expired medications in its drug kits, despite risks that the drugs might not work as intended in life-or-death situations. The crisis has eased a bit, but the agency still carries expired doses of two drugs in serving a city of 80,000 people.
“We’ve never [before] had to go diving back into the bin to try to retrieve expired boxes of drugs,” said Tom Wright, emergency medical services coordinator for the Bend Fire Department, which has been administering outdated medicines for about a year. “We had the backing of our insurance company that giving expired drugs is better than giving no drugs at all.”
He said medics have not reported any adverse reactions.
Medications are only guaranteed to work as intended until their expiration date. When stored properly, most expired drugs will not be harmful to patients but will become less effective with time, according to medical professionals. But EMS officials said it is often difficult to get information from manufacturers or regulators about how long medications will work.
The University of Utah’s Drug Information Service reports 275 medications are in short supply. Clinics and hospitals have reported struggles getting chemotherapy drugs to treat cancer and anesthetics used in surgery.
In the past two years, paramedics from different agencies have dealt with shortages of critical first-line drugs like Valium to treat seizures, dextrose 50 to boost the blood sugar of diabetics, and magnesium sulfate for eclampsia, an attack of convulsions during pregnancy. They have run low on painkillers and sedation drugs.
EMS directors say they are keeping a nervous eye on their supplies of epinephrine, for heart attacks and allergic reactions, and morphine, a painkiller.
Most of the shortages affecting emergency responders are of injectable generic medications. Drug manufacturers and the Food and Drug Administration say they are working aggressively to track and prevent shortages, but it could take years to get supplies back to normal levels.
“Drug shortages are not a new phenomenon,” said Dave Gaugh, senior vice president for regulatory sciences at the Generic Pharmaceutical Association. “What’s new is the crisis level they’re at today.”
Some agencies have reported keeping their drug kits fully stocked by substituting alternative medications, some of which have additional side effects or higher costs, or by diluting higher dosages to get the less-concentrated dose needed.
Even those stopgap solutions carry risks, though, as fast-moving paramedics have extra steps and new dosage protocols to remember under pressure.