Shortages of basic drugs and medical supplies have existed for years, but worsening shortfalls have industry groups sounding loud alarms.
Worrisome descriptions of patient harms due to shortages hail from a July survey of procurement professionals and other staff at nearly 200 hospitals and health systems.
Most said shortages were compromising patient care:
- 49% reported treatment delays.
- 32% reported being unable to provide a recommended drug or treatment.
- 21% believed patients received less effective drugs.
- 5% reported other adverse outcomes such as more central line-associated bloodstream infections, surgical site infections, and catheter-associated urinary tract infections.
The survey was conducted by patient safety organization ECRI and its affiliate, the Institute for Safe Medication Practices.
Most respondents reported that managing shortages constituted a daily struggle in the previous six months, with shortages lasting longer and affecting more life-saving drugs than in previous periods. The situation is so dire that 35% said they resorted to buying products on a “gray market.”
How patient care was compromised
Among the specific harms reported:
- Chemotherapy being postponed or reduced, or denied altogether when it’s intended to extend life or keep a dying cancer patient comfortable.
- Delays in treating low blood sugar due to dextrose injections no longer being stored in patient care areas.
- Medication disruptions due to defective IV tubes.
- Surgeries postponed or canceled.
- Patients moved to other facilities because spare parts are unavailable for broken equipment.
- Greater use of opioids due to scarcity of lidocaine, a local anesthetic.
And 24% of respondents reported at least one shortage-related drug error, such as:
- A patient received a less-than-therapeutic dose of ketamine when a lower concentration ketamine product was substituted for the usual strength, which was unavailable. The volume of the order was not increased to reflect the use of a weaker product.
- A nurse accidentally administered a whole 10 mg tablet of oxycodone rather than a half a tablet as prescribed. The hospital had run out of standard 5 mg tablets.
- Patients with breathing problems received a cystic fibrosis drug, dornase alfa, instead of albuterol due to a mixup in a clean room when staff were forced to combine albuterol from numerous small containers.
Respondents also worried that rampant drug substitutions could lead to undetected blunders, such as patients or caregivers administering a wrong dose because instructions were not clearly communicated.
More concerns about harm
Other industry surveys convey similar concerns:
- Among supply chain leaders, 48.6% said their facilities had to cancel or reschedule cases or procedures at least quarterly in 2022, according to Premier.
- Nearly a third of American Society of Health System Pharmacists members said drug shortages caused rationing, delaying, or canceling care.
- Of major cancer centers, 72% lacked sufficient carboplatin and 59% lacked adequate cisplatin — drugs used to treat many types of cancer, according to the National Comprehensive Cancer Network.
- The American Cancer Society reported that one in 10 cancer patients faced disruptions in treatment, including 18% of those on Medicaid.
Why all the surveys?
These surveys add pressure on Congress to act by giving context to the growing shortage lists. (The University of Utah Drug Information Service documented 309 active shortages as of July, and the FDA listed more than 120 drug shortages as of this writing.)
Several bills to strengthen the supply chain are pending, including at least two bipartisan efforts. The Medical Supply Chain Resiliency Act would establish a “trusted trade partner network” to drive domestic and nearshore production, and the Drug Shortage Prevention Act would require drug manufacturers to inform the FDA about their supply chains and implement risk management plans to mitigate shortages.
At a recent congressional hearing, Melissa Barber, a postdoctoral associate at the Yale School of Medicine questioned why essential medicines have not been viewed as a strategic focus of industrial policy, like semiconductors and agriculture. She said the idea that “we should trust markets to sort themselves” isn’t working.
The same might be said of non-drug medical supplies, which, as Axios reported, suffer from some of the same market pressures.
Reporting from the front lines
Journalists can look to medical literature for story ideas. For example, researchers at Virginia Commonwealth University Health System wrote a paper describing how physicians and pharmacists joined forces to prescribe alternatives when injections of the anxiety medication lorazepam were hard to come by.
Another angle is the five-year anniversary of Civica Rx, a not-for-profit drug manufacturer. A recent analysis in NEJM Catalyst suggested that the project successfully improved supply security and reduced costs for its member hospitals.
To show the impact of shortages, there’s no substitute for talking to patients. A powerful example is a PBS NewsHour report that showed the hardships of patients who scramble, often unsuccessfully, to fill their ADHD scripts. One father said he resorted to giving his own Vyvanse pills to his 15-year-old child, which caused his attention to drift while driving.
NewsHour producer Diane Lincoln Estes said in an email that her team posted on social media channels, asking people to share their experience with ADHD medication shortages.
“I think that the people who participated really wanted to be heard,” she said. “They all felt strongly that this issue deserves more attention, and that motivated them to talk to us.”
