Several health care professionals are calling attention to the severity and potential consequences of drug shortages, as the list of drugs listed on the FDA's website as "currently in shortage" grows by the day. 1 

Last week, National Association of EMS Physicians (NAEMSP) members joined with other health care professionals on Capitol Hill to bring attention to the issue of drug shortages, as emergency medical facilities are forced to severely restrict use of certain IV fluids, anti-nausea medications, and other essential emergency medications (EEMs), many of which, NAEMS leaders said, "have no suitable substitute."

Of the 176 EMS physician medical directors who responded to a survey NAEMSP conducted during its annual meeting in January 2019, 97% reported experiencing an EEM shortage in the past 6 months and 95% reported the shortages to be consistent or cyclical. 

Pharmacists are also feeling the sting of drug shortages, as a research letter published by University of Chicago oncologist Andrew Hantel, MD, published in JAMA Internal Medicine last month demonstrated.In that letter, Hantel discussed a survey he and his colleagues conducted of hospital pharmacy managers to assess whether the drug shortage problem is impacting care.

Of 719 pharmacy managers surveyed, all reported shortages, and most, 4 out of the 5 of the respondents, reported hoarding drugs or rationing. More than half of those surveyed reported shortages of at least 50 drugs within the previous year.

In that letter, Hantel and colleagues noted that "in severe cases, shortages require clinicians to decide which patients receive needed medications and which do not."  Of course, decisions such as these impact patient care, Erin Fox, PharmD, BCPS, FASHP said during a recently-held Pharmacy Times-led Peer Exchange. "At the most basic level, the impact is that they don’t get the treatment they need or there’s a delay in their treatment. Luckily, those types of shortages are very uncommon, but they’re also at more risk of having a medication error. When hospitals have to use a 2-mL vial versus a 5-mL vial or a 10-mL vial, accidents can happen and medication errors can happen."

The answer to the shortages will be multifactorial, as legislators work with federal health officials and members of the pharmaceutical industry to come up with answers. Solutions range from incentive programs that are used by medical facilities to encourage drug manufacturers to provide supplies in a timely manner and in sufficient quantities, to increased automated manufacturing facilities, to legislation proposed like the Affordable Drug Manufacturing Act, which proposes establishing a new office within the Department of Health and Human Services tasked with making drugs more affordable and accessible by increasing the number of available generics.4

Meanwhile, NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS reminded legislators that time is of the essence.

“We appreciate FDA’s notable efforts over the past several years in response to this issue, but unfortunately the situation remains dire for many patients not receiving the medications they need when they need them,” Tan said in a prepared statement. “We look forward to working with our federal, regional, state and local partners toward a long-term solution that ensures a stable, sufficient and redundant supply of these essential medications.”2


References
  1. Current and Resolved Drug Shortages and Discontinuations Reported to FDA. FDA website. www.accessdata.fda.gov/scripts/drugshortages/default.cfm?utm_campaign=04-25-2019%20Drug%20Shortages&utm_medium=email&utm_source=Eloqua&elqTrackId=93fcb2203d734ee7a488d9af81ad8f48&elq=9a9aa158cbee487287893d66f6fdd565&elqaid=7770&elqat=1&elqCampaignId=6375 Accessed April 26, 2019. 
  2. EMS Physicians Address Critical Drug Shortages in D.C. Hill Day. National Association of EMS Physicians® website. https://naemsp.org/home/news/ems-physicians-address-ongoing-critical-drug-short/ Accessed April 26, 2019. 
  3. Hantel A, Siegler M, Hlubocky F, et al. Prevalence and Severity of Rationing During Drug Shortage. JAMA Intern Med. March 25, 2019. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2728954?guestAccessKey=a2538f61-6f97-4fd5-b937-20476568c59a%20&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=042619 Accessed April 26, 2019. 
  4. Warren, Schakowsky Introduce Bicameral Legislation to Radically Reduce Drug Prices Through Public Manufacturing of Prescription Drugs. Elizabeth Warren's website. https://www.warren.senate.gov/newsroom/press-releases/warren-schakowsky-introduce-bicameral-legislation-to-radically-reduce-drug-prices-through-public-manufacturing-of-prescription-drugs Accessed April 26, 2019.