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Drug Supply Shortages: The RX Squeeze

Drug supply shortages have been plaguing the country for the better part of two decades and it doesn't look like a "cure" is on the horizon anytime soon. EMS certainly feels this impact and has not been spared with shortages of Glucagon, Epinephrine, Dextrose, Ketamine and even normal saline being commonplace. The problems though are far larger than this. Earlier this year, my own daughter had a prescription for Amoxicillin that wasn't able to be filled, so Augmentin had to be given as an alternative therapy for a middle ear infection. According to the FDA more than 130 drugs are in short supply including: cancer treatments, children's analgesics, antibiotics, cold medicine. The average shortage lasts for about 18 months, but there are several critical drugs that have been in shortage for more than a decade.

WHY the shortages?? How can this happen in a country with a sophisticated and well-funded healthcare system?? You've guessed it - there is more than one answer which is accompanied by more than one solution. In some cases, government policy or natural disasters actually holds us back. Sometimes, demand greatly exceeds supply (children's Tylenol) but in other cases it can be related to manufacturing supply problems around simply lacking the raw materials to make them (cancer drugs). To mitigate some of these problems, the FDA may temporarily allow exceptions which gives the green light for other countries to import chemotherapy drugs into the U.S. This is happening now. As you can imagine with cancer drugs, patient care could be compromised due to the temporary supply chain disruptions. The frustrations from doctors, EMS personnel, and even patients are palpable.

The graph below shows that the number of new drug shortages occurring each year has been a serious problem for an extended period.

We also cannot lose sight that in our field, drug shortages may also increase the rate at which medication administration errors occur. The substitution of drugs in an attempt to provide treatment when regular medications are unavailable, require paramedics to handle unfamiliar substances, packaging and dosages. At least, the perception practitioners had in one survey indicated this was the case. Respondents estimated that error rates rose by 1% to 5% and unsafe patient conditions were the result 60% of the time DOI: 10.1310/hpj5004-279.

Some ways to Cope until things improve (permanent execution even in the absence of a shortage wouldn't hurt):

  • Have flexibility built into your local EMS protocols. Consider alternatives/substitutes in the same drug class.

  • Exercise active inventory management practices - including drug status and substitutions. Work directly with your vendors.

  • Have expiration date awareness - the FDA may give guidance to extend certain things beyond their original expiration date.

  • Build partnership with your area hospitals - this may be able to help you!

  • Be vocal + keep the pressure on the legislators -- Congress should continue addressing these challenges.

  • Consider conservation efforts (reserve for the most critical). Beware of inequity perceptions as a drawback.

  • Use color coding to avoid medication errors.

June 19, 2023

Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP

Pass with PASS, LLC.

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