Researchers Note Alarming Increase in Emergency Drug Shortages

A recent study found that between 2008 and 2014, there has been a startling increase in drug shortages for medications used in emergency care and treatment. According to the study, these shortages rose a staggering 435% during this time period.

The study, entitled Longitudinal Trends in U.S. Drug Shortages for Medications Used in Emergency Departments (2001-2014), was published in January of this year (Academic Emergency Medicine 2016;23:63–69 © 2015 by the Society for Academic Emergency Medicine). Led by Kristy Hawley, MPH, the study aimed to document and analyze trends in reported drug shortages in emergency medicine over a period of 13 years (2001 – 2014).

Drugs Most Frequently on Short Supply

The study found that there were a total of 1,798 reported drug shortages between January 2001 and March 2014. Of these, 610 were classified as Emergency Care Drugs. The emergency drug shortages most affected the treatment of infectious diseases with a total of 148 shortages, or  24.3% of all emergency drug shortages. Analgesic drugs made up 9.3% with 57 shortages; and critical care drugs accounted for 8.2% with 50 total shortages over the 13 year period.

Some of the specific emergency care medications listed as having the most frequent shortages included:

• Acyclovir injection
• Hydromorphone
• Epinephrine 1 mg/mL injection
• Pantoprazole
• Dexamethasone
• Nitroglycerine injection
• Phenobarbital Elixir
• Lidocaine/epinephrine

Each of the pharmaceuticals listed above experienced at least six reported shortages between January 2001 and March 2014. The median length of the shortages was nine months.

Reasons for the Shortages

The study’s authors cited a number of reasons for the emergency care drug shortages. The most common reasons included:

• Manufacturing delays/problems: 156 shortages
• Supply and demand: 91 shortages
• Raw materials: 27 shortages
• Discontinued: 23 shortages
• Business decision: 13 shortages
• Regulatory: 11 shortages

According to the study’s authors, other reasons for the shortages may be due to the economic downturn in 2008, quality control problems or changes to the FDA’s inspection methods, group purchasing organizations, changes to the Medicare Part B reimbursement policy, or low profit margins.

Other Findings of the Study

Diana Swift, of Medscape, reported on this study in her article, Emergency Care Drug Shortages Rose 435% in 2008-2014. Some of the findings Swift made note of include:

• Though the number of emergency care drug shortages decreased between 2002 and 2007, from January 2008 until March 2014, the number increased by 435% (from 23 to 123).
• Shortages of drugs used for lifesaving interventions or high-acuity conditions increased by 393% (from 14 to 69) during this period.
• The majority of the drug shortages involved generic sterile injectables, which may be due to low reimbursement rates through Medicare Part B.

Conclusion

The study’s authors write that “With increasing drug shortages in the United States, hospital systems and pharmacies need to inform front-line providers of these shortages and have hospital-wide protocols available for delivery of care when critical drugs are on shortage.” They believe that the root cause of these shortages “should be aggressively explored at the national level by policymakers, manufacturers, physician-led organizations, and patient advocacy groups.” Indeed, patients’ lives are on the line. More must be done to prevent high rates of drug shortages.