Drugs

By Victoria Colliver
June 22, 2015
Updated: June 22, 2015 5:17pm

Drug shortages have turned into a nationwide chronic condition.

Disruptions in production, safety recalls, difficulties finding key raw ingredients, shifts in demand and decisions to discontinue certain products are just some of the reasons pharmaceutical makers give for not having enough supply. Nearly half the time, research shows, the reason is not disclosed, but the problem has escalated over the past five years.

A law, passed by Congress in 2012, requires drugmakers to notify the Food and Drug Administration of any disruption as soon as possible. With early warning, the FDA can make arrangements with other manufacturing plants, streamline regulations and assist drugmakers with such problems as finding alternative ingredient sources. That’s helped fend off some threatened shortages, but the problem persists.

Erin Fox, a pharmacist who directs the University of Utah Health Care Drug Information Service, which maintains a list of drugs in scarce supply, said the FDA’s efforts have helped keep some new shortages from emerging, but “a good 250” drugs are still in short supply. “That number of ongoing shortages is sticking around,” she said.

Bianca Von Trier, a transgender woman, experienced the shortage about two weeks ago when she tried to pick up her supply of an injectable hormone at a drugstore in San Francisco. She was shocked when the pharmacist told her the drug was out of stock.

“It’s kind of like going to the store and not finding milk,” said Von Trier, who because of her gender transition has to take the drug for the rest of her life. “I couldn’t believe I was hearing that. What is this, the Third World or something?” The drug Von Trier needed is a hormone called estradiol valerate.

The drugs in short supply in the U.S. take in a wide range, from common antibiotics and painkillers to critical life-saving therapies for cancer and other conditions. They mostly involve lower-cost generics, but also include brand-name medications.

Recurring problem

Sometimes a shortage for a particular drug will get resolved, but then the medication becomes unavailable again. Drugs can go on and off the shortage lists for years.

Droperidol, a drug often used in hospitals to combat post-anesthesia nausea, has been completely unavailable for two years due to a raw material shortage. Nitrogylcerine injections, often the first line of defense in cases of heart attack, are on back order. Manufacturing delays are to blame. Shortages of the bladder-cancer treatment known as BCG — for Bacillus Calmette and Guérin — has caused harrowing delays in treatment for patients.

The problem has affected such basic drugs as epinephrine, which treats allergic reactions; the antianxiety drugs lorazepam and diazepam; narcotic pain relievers fentanyl and morphine; and the narcotic antidote naloxone. All of them were on and off the shortage lists at least 50 times between 2001 and 2013.

“Shortages are now a way of life,” said Bona Benjamin, a pharmacist in charge of medication-use quality improvement for the American Society of Health-System Pharmacists, which tracks shortages nationwide.

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