Why Are There Drug Shortages?
Causes of Drug Shortages
What is a drug shortage?
Essentially, in the past few years there has been multiple shortages of medications available. This is more confined to injectable medications that are more often used in the hospital or in outpatient facilities (eg. infusion center, skilled nursing). Overall, this impact has not been noticed in the outpatient dispensing pharmacies, and currently does not appear to be a major issue. However, the concern comes into play for patients who use an injectable agent that is not necessarily mass-produced, such as chemotherapy.
Why does this happen?
There are multiple factors that come into play for why there are different drug shortages:
- Shortage of materials to produce medications - just as there can be shortages for other things we use in life that drive up prices (eg. gas) the same can happen to the chemicals and supplies to make medications
- Discontinuation of production for certain medications - a company may decide to stop production of medications, because quite frankly, it may not be profitable. This is especially the case in which generic injectables (eg. Lasix/furosemide [a diurectic]), are simply not profitable to mass produce. As such, the market shrinks to just a few mass-producers who due to supply and demand can still make a profit off of these cheap medications.
- Manufacturing problems - Drugs are produced in lots, in fact, if you look at some prescriptions that come in their own packages you will see next to the expiration dates the lot # they came from. This helps manufacturers track down medications they may think there is an issue with. Similar to how there have been car recalls due to errors in machinery and function, the same can happen to medications. Sometimes things can get into the medications (eg. particles or non-refined ingredients), and this necessitates a drug recall. Where this is a greater issue is when their is only a few companies making this drug, and thus the supply could be halved overnight.
These are some of the major issues. One troubling problem has been that some companies or wholesalers buy up low drug stocks to create an artificial shortage which drives prices up for hospitals and others. This of course is an issue and persued by heavily by the FDA and other legal agencies.
So what are we doing to stop this?
Currently, many organisations are working together with the government and the FDA to help speed up production of medications and to recognize when there may be shortages to help prepare.
Currently, however, health professionals are working towards making sure that if a drug would run out, there are other agents to utilize instead. For example, there was a time when IV Ativan/lorazepam was on backorder. As such, other medications in that class were substituted as needed to help preserve that drug for certain indications.
Should you be worried?
Overall, this has been going on for years, and most patients do not notice it. This is because health care professionals and hospitals are working towards being more strict with drug usage to make sure the patients who need certain medications recieve them. Others will get drugs that are equivalent and work as well, but may not be the bread-and-butter of normal practice.
The patients who are most concern are those who receive chemotherapy for treatment. This is especially the case with drugs that again are not made as frequently. These patients are usually in contact with their physicians to ensure that steps are being made to secure a supply of medications for their treatment. If none is available, alternative treatments may have to be used. However, this is rare and fare between.