Health care crisis: Severe shortages of some emergency room drugs

A new study published in the journal Academic Emergency Medicine reveals that there are severe shortages of some emergency room drugs critical to patient care.

There are many drugs for which there are adequate substitutes.  But several medications have no corresponding generic alternative, which can threaten patient lives.

Chicago Tribune:

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 emergency room physicians assessed whether the reported shortages had to do with drugs used in ERs, then looked at whether they were associated with lifesaving or acute conditions.

Of the nearly 1,800 drug shortages reported between 2001 and 2014, nearly 34 percent were used in emergency rooms. More than half (52.6 percent) of all reported shortages were of lifesaving drugs, and 10 percent of shortages affected drugs with no substitute. The most common drugs on shortage are used to treat infectious diseases, relieve pain, and treat patients who have been poisoned. Though the number of shortages fell between 2002 and 2007, they've risen by 435 percent between 2008 and 2014.

That's nothing less than a public health crisis, said Jesse Pines, director of the office for clinical practice innovation at George Washington University School of Medicine & Health Sciences and the study's senior author. Shortages "are real, they're happening, and they're getting worse," he said. Pines, who practices emergency medicine, said that though emergency rooms are implementing things like providing posters with quick alternative drug options, there's no obvious way to cut shortages.

The primary reasons given for shortages were manufacturing delays (25.6 percent), supply and demand (14.9 percent), and availability of raw materials (4.4 percent). Pharmaceutical companies listed "business decision" as the reason for a shortage 2.1 percent of the time. But in over 46 percent of the shortages studied, there was no reason given.

No reason for the shortages in almost half the cases?  This has more to do with the bottom line of drug companies than anything else:

It seems simple enough: If companies produce more drugs, more drugs will be available to ERs. But given that the majority of drugs on shortage in emergency rooms are sterile injectables with low profit margins, don't expect that to happen anytime soon. "There are many ways to mitigate drug shortages, but there's no magic bullet to solve them," said Pines. "This could and potentially will get worse."

The situation is similar to the "orphan drug" problem in the 1990s, when incentives for producing drugs to treat rare diseases helped address a serious gap in the health care system. 

But this is a long-term solution.  In the meantime, people may die because it just isn't profitable enough to manufacture drugs that can save them.  Companies have a fiduciary responsibility to their shareholders and are not in the business of losing money.  But a solution has to be found to avoid a full-blown health care catastrophe.

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