Drug Shortages: The New Norm in Health-System Pharmacy

JANUARY 21, 2016
Drug shortages have become the new norm in health-system pharmacies. 
 
Attending meetings to discuss new and existing drug shortages, inventories on hand, and reasonable alternative therapies is not the most enjoyable task for anyone in the pharmacy department. It can be difficult for multidisciplinary task forces to keep up with the increasing number of drug shortages, in addition to explaining the processes and reasons behind shortages to nurses or physicians who are not familiar with the drug supply chain. 
 
This is particularly true when no alternative therapies exist. Those who practice in emergency departments encounter this type of critical drug shortage often, and new research has highlighted their struggle.1

A team of investigators recently reviewed more than 1700 drug shortages between 2001 and 2014 with the aim to describe the longitudinal trends in drug shortages related to emergency medicine practice. Of the identified shortages, more than one-third of the drugs were within the scope of emergency medicine practice, and more than half of them were used for lifesaving interventions or high-acuity conditions.
 
While these absolute figures are troubling, what’s even worse is that drug shortages for lifesaving interventions or high-acuity conditions climbed 393% from January 2008 to March 2014, while shortages with no alternatives increased 125% in the same time frame.

A common source of frustration with drug shortages stems from attempting to determine why they exist. Almost half of the emergency medicine-related shortages seen in the studied time period had unknown causes. These troubling figures play into the fear that future drug shortages are inevitable and can occur with little notice and at any time. 

Initiating protocols to substitute available alternatives can introduce a new set of complications. Given the critical nature of most medical emergencies, providing a drug unfamiliar to nurses and physicians may impact the quality of care delivered to patients.2 With generic drugs skyrocketing in price, that alternative agent may also be more expensive.
 
One example of this is doxycycline. The antibiotic’s inflated cost has impacted its use in common emergency medicine encounters such as Lyme disease prophylaxis and pelvic inflammatory disease.

The trends reported in this research are troubling signs for emergency medicine, as new medications to treat life-threatening situations rarely come to market.
 
References
1. Hawley KL, et al. Longitudinal trends in U.S. drug shortages for medications used in emergency departments (2001–2014). Acad Emerg Med. 2016;23:63-69.
2. Mazer-Amirshahi M, et al. Critical drug shortages: implications for emergency medicine. Acad Emerg Med. 2014;21:704–711.

Craig Cocchio, PharmD
Craig Cocchio, PharmD
Craig Cocchio, PharmD, BCPS, is an Emergency Medicine Clinical Pharmacist at Trinity Mother Frances Hospital in Tyler, Texas. Follow on Twitter @iEMPharmD and on his blog at empharmd.blogspot.com
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