Painkiller, sedative shortage raises concerns
WASHINGTON — A shortage of painkillers and sedatives for COVID-19 patients struggling to breathe is causing concerned hospital groups to seek changes to increase the supply of these drugs.
Patients with more severe cases of the viral respiratory illness may require ventilators, which are machines that help with breathing. But the process of inserting a plastic tube into a patient’s airway is painful and requires pain medicine and sedation.
Beverly Philip, the presidentelect of the American Society of Anesthesiologists, said patients in the ICU who use a breathing tube for a ventilator often need medicines to help relax or ease pain, as well as muscle relaxants to help their bodies accept the ventilator.
“These are part of routine needs in the intensive care unit,” she said.
Drugs such as morphine, hydromorphone and the synthetic opioid fentanyl are used to relax COVID-19 patients. Cisatracurium, a commonly used muscle relaxant, and general anesthesia drugs like propofol are often in short supply. Many patients need a combination of these drugs.
“Although elective surgeries are dramatically down, the fact that you have to ventilate patients with COVID for sometimes as little as five to seven days, but sometimes for two weeks or longer, means that the total amount of drugs necessary would be greater than a hospital normally uses,” said Lee Fleisher, chairman of the Department of Anesthesiology and Critical Care at the University of Pennsylvania Health System, who has observed the shortages.
The Food and Drug Administration is working with the manufacturers of drugs such as fentanyl and morphine “on anything that can be done to increase supplies,” said Nathan Arnold, an agency spokesperson.
A spokeswoman for AbbVie, which makes Nimbex, a brand of cisatracurium, said the company “is working closely with the FDA on potential solutions to address the temporary shortage and is working in parallel to accelerate supply where possible.” The drugmaker has seen a significant spike in demand for the drug for ventilator-assisted treatments, spokeswoman Adelle Infante said.
Diprivan, a brand of propofol, is manufactured by Fresenius Kabi in Europe, and the company said the plants are running at maximum capacity.
The American Hospital Association has called the issue a major concern and is pushing for additional flexibility for compounding pharmacies and outsourcing facilities to make and distribute these drugs.
Philip said the ASA and others recently convinced the federal Drug Enforcement Administration to start addressing the shortage in another way: by increasing limits on certain drugs sold to hospitals, such as some potentially addictive painkillers. Earlier this month, the DEA raised the quotas for hospitals on fentanyl, morphine, hydromorphone, codeine, ephedrine, pseudoephedrine and other drugs by 15 percent.
Health care consulting company Premier Inc., which serves an alliance of 4,000 U.S. hospitals, cautioned that even with the increase in quotas, the finished products are not likely to enter the marketplace until May or June.
Data from Premier shared with CQ Roll Call showed that the use of propofol as a first-line sedative increased over 300 percent from 2019 to 2020. Demand is expected to increase as elective surgeries begin to resume.
The shortages of these drugs can be found nationwide, but hospitals in “hot spot” areas for the virus reported more difficulties.