Wednesday, October 13, 2010

Drug Shortages in the United States

One of our pharmacists asked me "Are we now in Sudan?"

It seems like we are a third world country because we are dealing with serious and nationwide pharmaceutical shortages for needed drugs.  Medications like Propofol (yes, the one that killed Michael Jackson) and Succinylcholine, a neuromuscular drug that is commonly used in surgery, are in such short supply that we are canceling surgeries and trading those drugs between hospitals. It is just the tip of the iceberg.  Other drugs like metoclopramide, vecuronium and even ephedrine are limited.  Every week we find a new shortage.

What the heck is going on?  Because these drugs are generic, only a few companies manufacture them.  If one stops, it creates a shortage that is not easy to rapidly correct.  In the case of Propofol (used in anesthesia and even for conscious sedation in emergency rooms and for colonoscopies), two of the three manufacturers stopped making it and that left only one to supply the entire market.   The situation was only resolved when the Food and Drug Administration (FDA) stepped in and allowed the temporary importation of a European drug called Fresenius Propoven to enter the Country and ease the shortage.

Most of these medications are sterile injectibles and are generic.  When a decrease in the number of companies making an older, less profitable drug is coupled with problems in manufacturing, shortages occur and that is what is happening right now.

In my health care organization, we are monitoring shortages weekly and developing ways to ensure the most sick and acute patients get the treatment they need.  I hand carried 2 vials of Succinylcholine to one of our rural hospitals last week, 400 miles round trip.  Today I was told that one of our Surgi-centers is getting a few vials from a hospital that just got a shipment.  We are learning to share and that is a good thing.

Yesterday I listened to the deliberations going on in the Supreme Court, dealing with lawsuits against vaccine manufacturers, who have already set up a no-fault Vaccine Injury Compensation Fund for injured children.  Although this fund has paid over $1 billion for vaccine related complications,  the attorneys believe that does not protect the companies from further litigation.  If the Courts allow people  to tap into a monetary fund and then sue on top of that, I predict we will slip into a true third world country where mumps, measles and chickenpox ravage our population.  The vaccine manufacturers will just stop making the drug.

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