Hospitals hunt substitutes as drug shortages rise

By LAURAN NEERGAARD, AP Medical Writer
30 May 2011 WASHINGTON — A growing shortage of medications for a host of illnesses – from cancer to cystic fibrosis to cardiac arrest – has hospitals scrambling for substitutes to avoid patient harm, and sometimes even delaying treatment. “It’s just a matter of time now before we call for a drug that we need to save a patient’s life and we find out there isn’t any,” says Dr. Eric Lavonas of the American College of Emergency Physicians. The problem of scarce supplies or even completely unavailable medications isn’t a new one but it’s getting markedly worse. The number listed in short supply has tripled over the past five years, to a record 211 medications last year. While some of those have been resolved, another 89 drug shortages have occurred in the first three months of this year, according to the University of Utah’s Drug Information Service. It tracks shortages for the American Society of Health-System Pharmacists. The vast majority involve injectable medications used mostly by medical centers – in emergency rooms, ICUs and cancer wards. Particular shortages can last for weeks or for many months, and there aren’t always good alternatives. Nor is it just a U.S. problem, as other countries report some of the same supply disruptions. … There are lots of causes, from recalls of contaminated vials, to trouble importing raw ingredients, to spikes in demand, to factories that temporarily shut down for quality upgrades. Some experts pointedly note that pricier brand-name drugs seldom are in short supply. The Food and Drug Administration agrees that the overarching problem is that fewer and fewer manufacturers produce these older, cheaper generic drugs, especially the harder-to-make injectable ones. So if one company has trouble – or decides to quit making a particular drug – there are few others able to ramp up their own production to fill the gap, says Valerie Jensen, who heads FDA’s shortage office. The shortage that’s made the most headlines is a sedative used on death row. But on the health-care front, shortages are wide-ranging, including:

Thiotepa, used with bone marrow transplants.
A whole list of electrolytes, injectable nutrients crucial for certain premature infants and tube-feeding of the critically ill.
Norepinephrine injections for septic shock.
A cystic fibrosis drug named acetylcysteine.
Injections used in the ER for certain types of cardiac arrest.
Certain versions of pills for ADHD, attention deficit hyperactivity disorder.
Some leuprolide hormone injections used in fertility treatment.

No one is tracking patient harm. But last fall, the nonprofit Institute for Safe Medication Practices said it had two reports of people who died from the wrong dose of a substitute painkiller during a morphine shortage. …