Tessa Quinn
Hospitals running out of medication is a very real concern and an ongoing issue. In recent years, unexpected drug shortages have become common in the United States, Canada, and Western Europe. This can be due to pharmaceutical companies halting production because of quality concerns, raw material shortages, or natural disasters. When this happens, hospitals have to make difficult decisions about how to allocate their remaining drugs, and may even need to make their own. However, this is not always a viable option, as it takes time and resources for hospitals to begin drug production.
| Characteristics | Values |
|---|---|
| Reason for hospitals running out of meds | Pharmaceutical companies halt production; Raw materials needed to make medications or medical supplies run low; Natural disasters |
| Examples of drugs in shortage | Cytarabine, an essential drug used to treat and cure certain kinds of acute leukemia; Nitroglycerin; Bleomycin |
| Solutions | Manufacture generic medications; Reserve drugs for the sickest patients; Obtain special permission to import drugs from other countries; Hospitals make their own drugs |
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What You'll Learn
Drug manufacturing as a solution
Hospitals running out of medications is a common issue that has been on the rise in recent years. Drug shortages are a global issue affecting countries of all income levels. Several factors contribute to this problem, including manufacturing difficulties, raw material unavailability, regulatory issues, business decisions, and disturbances within the supply chain.
Drug manufacturing is one proposed solution to address drug shortages. This approach aims to increase domestic manufacturing capabilities to reduce reliance on foreign sources and mitigate geopolitical risks. Advanced manufacturing technologies, such as continuous manufacturing, are suggested to lower the likelihood of disruptions. However, implementing these technologies can be challenging due to economic factors, particularly for drugs with low margins.
Another aspect to consider is the quality of drug manufacturing. Hospitals, as the buyers, do not always prioritize manufacturing quality and reliability, leading to shortfalls in both domestic and foreign facilities. To ensure the effectiveness of increased domestic manufacturing, it is crucial to address the root causes of manufacturing quality problems. This includes investing in updated production technologies and incentivizing manufacturers to maintain high standards.
While drug manufacturing can be part of the solution, it is not a comprehensive answer. Hospitals becoming drug manufacturers themselves is impractical due to the variety of medications needed and the specialized nature of drug production. Instead, a strategic approach is necessary, incorporating various solutions such as risk mitigation through diversification, buffer inventories, and reforms to hospital payments.
In conclusion, drug manufacturing can play a role in mitigating drug shortages, but it should be one component of a multifaceted strategy. By addressing manufacturing quality, adopting advanced technologies, and implementing strategic policies, we can work towards reducing drug shortages and improving patient care.
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The gray market for drugs
Hospitals are facing the challenge of drug shortages, which can impact their ability to provide essential treatments to patients. This issue has gained attention through investigations like those conducted by the Committee on Oversight and Accountability Democrats and the Senate Commerce Committee, which have exposed the existence of a "gray market" for drugs.
The gray market refers to a network of private companies or brokers that take advantage of drug shortages to charge exorbitant prices for medications. These companies obtain drugs that are in short supply and sell them at marked-up prices, with each intermediary in the pipeline increasing the cost. This results in hospitals paying extremely high prices for drugs that are desperately needed. In some cases, units that normally cost $10 to $20 were marked up to $200 or more in the gray market.
An example of a drug that faced a critical shortage is cytarabine, which is used to treat certain types of acute leukemia. Hospitals struggled to obtain this medication, and some considered turning to the gray market as a potential solution. However, the provenance of drugs obtained through this market cannot be assured, and there are concerns about the involvement of unauthorized distributors.
To address the issue of drug shortages and the impact of the gray market, legislators like Sen. Bernie Sanders and Rep. Elijah E. Cummings have introduced bills aimed at curbing skyrocketing prices of generic drugs and reforming gray market drug sales. These efforts recognize the strain that high drug prices can have on hospitals, patients, and government programs like Medicaid and Medicare.
While the gray market for drugs may provide a temporary solution to drug shortages, it also raises concerns about the safety and affordability of medications. Hospitals must navigate these challenges to ensure they can continue providing essential care to their patients.
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Prioritising patients
Hospitals can sometimes run out of medication due to shortages, and this has become a common issue in the United States, Canada, and Western Europe. When this happens, hospitals must prioritise patients to ensure that the sickest patients receive the medication they need.
In one instance, Duke University Hospital ran out of cytarabine, a drug used to treat acute leukaemia. They had to decide how to manage the shortage and decided against accessing the "grey market", where the provenance of medications cannot be assured. Instead, they asked oncologists to consider alternative treatments that did not involve cytarabine. They also decided to prioritise children with acute myeloid leukaemia, as the cure rates are higher in children, and they require smaller doses of the drug.
Another example is the shortage of nitroglycerin, which led to emergency departments reserving it for initial doses and then switching to other medications after 24 hours. Similarly, when the chemotherapy drug bleomycin was in short supply, pediatric oncology departments had to quickly estimate how much medication they needed to treat children with cancer.
To address drug shortages, some hospitals have their own compounding pharmacies that can produce medications from raw materials. However, this is not a feasible solution for most hospitals, as it can be challenging to increase production quickly, and there is often little advance warning of an impending shortage. As a result, hospitals must make difficult decisions to prioritise patients and ensure that those with the greatest need receive the necessary treatment.
Overall, drug shortages in hospitals can have significant impacts on patient care, and prioritisation of patients becomes essential to mitigate the negative consequences of these shortages.
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Natural disasters
In the aftermath of a natural disaster, hospitals may experience an influx of injured patients, placing immense pressure on their emergency departments and resources. The disruption to supply chains can result in delayed resupply, leading to shortages of critical medications and supplies. This includes drugs like insulin, prednisone, and seizure medications, which are typically not stocked in large quantities. Additionally, hospitals rely on regular deliveries of essential items such as linens, scrubs, gauze, syringes, and gloves, which can also be in short supply during disasters.
To mitigate the impact of medication loss, individuals are advised to prepare ahead of time. This includes ensuring they have enough medication to last for a few weeks, as evacuations and disruptions to infrastructure may hinder immediate access to refills. In some states, such as North and South Carolina, pharmacists are permitted to provide up to a 30-day supply of prescription medication during a natural disaster, even without a doctor's authorization.
It is important to note that hoarding medications can be costly and dangerous. Instead, individuals should familiarize themselves with emergency procedures, such as locating open pharmacies, utilizing community health centers, or seeking urgent care clinics for short-term prescriptions. Understanding the specific risks and preparing accordingly can help ensure access to necessary medications during a natural disaster.
Furthermore, hospitals can also implement preparedness measures to minimize medication loss. This includes raising awareness among patients and staff about the impact of medication loss, developing contingency plans for supply chain disruptions, and following guidelines for safe drug use after a natural disaster, such as inspecting medications for contamination or exposure to high temperatures. By combining individual and institutional preparedness, the risk of hospitals running out of medications during a natural disaster can be significantly reduced.
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Compounding pharmacies
Hospitals can sometimes run out of medication, and this has been a common issue in the United States, Canada, and Western Europe. In such situations, compounding pharmacies can be a solution.
In the case of Duke Hospital, they were able to avoid a disaster during a shortage of cytarabine, a drug used to treat acute leukemia, by producing the medication in their compounding pharmacy.
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Frequently asked questions
Yes, hospitals do sometimes run out of medication.
There are several reasons why hospitals may run out of medication. Pharmaceutical companies may halt production due to quality issues or concerns about meeting FDA standards. Natural disasters can also cause shortages, such as the hurricane that hit Puerto Rico in 2017, which disrupted the production of medications and IV saline bags.
When a hospital runs out of a critical drug, they may have to reserve it for the sickest patients. They may also ask doctors to switch to alternative treatments that don't involve the drug in short supply. In some cases, hospitals may decide to prioritize certain patient groups, such as children with higher cure rates and lower drug requirements.
Some large hospitals have their own compounding pharmacies that can produce drugs from raw materials. However, this is not a practical solution for every hospital, and it can take a significant amount of time to increase production of a particular drug.
To prevent drug shortages, a consortium of healthcare systems has announced plans to establish a nonprofit company to manufacture generic medications. This will help ensure a stable supply of medications and avoid reliance on external production facilities.
