Imagine rushing a loved one to the emergency room, only to find treatment is impossible because a needed drug is out of stock.
From 2008 to 2014, the number of drug shortages in US emergency departments spiked by 435 percent, from 23 reported shortages to 123, according to a recent analysis. The majority of the unavailable drugs are used for direct, life-saving interventions. For some, no substitute was available.
Those are the findings of a December study in the journal Academic Emergency Medicine. The effect of those shortages on patient health has not been assessed.
"We're currently in a public health crisis with rising drug shortages, and the most concerning thing is that it's likely to only get worse," says study author Jesse Pines, director of the Office for Clinical Practice Innovation at George Washington University School of Medicine and Health Sciences.
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As an emergency physician in Washington, D.C., Pines began to notice that more and more of the drugs he gave patients in the ER seemed to be unavailable. Because there was little known about drug shortage trends, he and colleagues dug into data collected by the University of Utah Drug Information Service from the American Society of Health-System Pharmacists website, which posts public information on shortages and estimated resupply dates.
Pines and a colleague whittled down a list of 1,798 shortages from a 13-year period to 610 drugs used in emergency medicine. Of those 610 reported shortages, 52.6 percent were drugs used as life-saving interventions, such as epinephrine for life-threatening allergic reactions. During a shortage, a doctor may reach for a familiar alternative. If one isn't available, they may be forced to rely on a less effective medication or one with which they have less experience, which can lead to an increase in medication errors, higher costs, and/or less time with patients.
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Even more problematic, 32 of the drugs Pines and his team identified had no available substitute at all, including a snake anti-venom — on shortage five times during the study period — and a post-exposure rabies medication needed to prevent deadly infections. "It is very concerning if there is a life-saving medication for a condition, but it's just not available," says Pines.
While the number of drug shortages fell from 2002 to 2007, it sharply increased from 2008 to 2014. Drug shortages may be caused by manufacturing delays or problems, supply and demand issues, or lack of raw materials.
The team could not concretely determine why there has been such a sharp increase in shortages since 2008, though it may be linked to the economic downturn following the 2008 financial crisis. Increased FDA oversight of drug manufacturers and low Medicare reimbursement rates are two other possible causes; the former can make it more costly to manufacture a drug, while the latter may reduce already low profits, especially for generic drugs.
Quantifying the shortages is one thing, but solving them will be a much greater challenge. "I don't think there is any silver bullet for drug shortages, short of the federal government becoming a drug manufacturer, which is not going to happen," says Pines. "There really is no simple solution to this."