Ongoing drug shortages force providers to find workarounds

Every Friday, a manager at Edward-Elmhurst Health in suburban Chicago sends a list to the staff of about 35 drugs that are in short supply.

They run the gamut—injectable anesthetics like lidocaine, antibiotics, eyedrops, sedatives, cardiac drugs, diuretics. But the most crtitical shortage involves pre-filled injectable opioids like Dilaudid, fentanyl and morphine. They are used to sedate patients before surgery and manage pain after an operation as well as for trauma, burn or cancer patients.

Twice a week, Edward-Elmhurst has internal pharmacy calls to get a handle on what products they have on hand, review the latest news on suppliers and coordinate with clinicians to explore options. Managing shortages has been a regular practice over the past two years, said Phil Williams, the system’s associate vice president of pharmacy services.

“We have limited resources to begin with, so diverting resources to source product, develop alternatives and meet with physicians takes a significant amount of time,” he said. “We are spending 40 to 60 hours a week just dealing with myriad shortages.”

While three-hospital Edward-Elmhurst hasn’t had to delay or cancel surgeries, taking the time and spending the money to mitigate the shortages have made a significant dent in its budget. Without the necessary supply of injectable opioids, other providers have had to put off treatment, according to a survey from Premier, the group purchasing and consulting organization.

More than 96% of 116 of Premier’s member health systems surveyed said they are experiencing moderate to severe shortages of injectable narcotic medications. Nearly 60% reported the shortages affected patient care, including delaying or canceling surgeries or lowering patient satisfaction scores.

The shortages and manufacturing delays are expected to last through the second quarter of 2019.

The supply of injectable painkillers has been hamstrung as Pfizer, the largest manufacturer of the drugs, continues to upgrade its facility in McPherson, Kan., which has taken longer than expected. The plant was one of a number the company added when it acquired Hospira in 2015 for about $17 billion.

Other companies can’t make up the difference because they don’t have the capacity. Even if they did, the Drug Enforcement Administration is unwilling to give them large amounts of raw materials. The DEA implements annual caps on the amount of raw material a manufacturer can use to make opioids—one mechanism it has to try to limit the diversion of the drugs amid the addiction epidemic.

“We understand and support the DEA’s goal to be judicious about the production of narcotics, but we believe we are in the midst of a public health crisis,” Mike Alkire, Premier’s chief operating officer, said in a statement. “A temporary reallocation of supply quotas would allow others to step into the void, potentially addressing a multiyear shortage in a matter of months.”

Systems have been able to work around the shortages by giving opioids to patients orally and substituting muscle relaxants and other painkillers for opioids. But when providers have to scramble to find alternatives, they are more prone to making mistakes.

The situation for saline bags, however, is improving. The supply chain was greatly disrupted after Hurricane Maria decimated Puerto Rico, which is home to more than 50 drug manufacturers. Many of the facilities have resumed production, and alternative sources including manufacturers in Mexico and Australia helped bolster supplies.

Part of the problem facing providers can be blamed on consolidation among generic-drug manufacturers. Few providers consistently receive advance notice from drug manufacturers, wholesalers, distributors, group purchasing organizations or the Food and Drug Administration about impending shortages.

“We used to have five or six manufacturers for a particular product, now we are down to one or two,” Williams said. “If there is a raw product issue or problem with the FDA, that throws a significant wrench in the entire supply chain.”●

Want to continue the conversation about opioids? Join Modern Healthcare on April 25-26 at its Opioid Crisis Symposium. Register at ModernHealthcare.com/CCOpioids