Drug shortages in US emergency rooms on the rise

An emergency department sign. (iStock)

U.S. emergency rooms are increasingly running short on medications, including many that are needed for life-threatening conditions, a recent study documents.

Since 2008, the number of shortages has risen by more than 400 percent, researchers found. Half of all emergency room shortages were for life-saving drugs, and for one in 10 there were no available substitutes, they report in Academic Emergency Medicine.

Half of the individual shortage incidents had no explanation, the authors found. The rest had a variety of systemic causes that add up to a U.S. drug supply too low to meet public demand.

"Drug shortages are of particular concern in emergency care settings where providers must rapidly treat ill and injured patients," said lead author Kristy Hawley of the George Washington University School of Medicine and Health Sciences in Washington, D.C. "For most medications, substitutes exist but may not be as effective and may have more side effects, or providers may not have as much experience with them," she told Reuters Health by email.

The researchers looked at U.S. data on drug shortages between 2001 and 2014. The information came from hospital doctors' reports, and it's possible there were additional unreported shortages, the authors note.

The number of shortages declined steadily between 2001 and 2007 but began a sharp, continual rise in 2008.

Of the 1,798 shortages reported over the 13-year period, 610, or about one third, were for drugs used in emergency medicine. Over half of these were shortages of drugs used as lifesaving interventions or for high-risk conditions.

The average shortage duration for emergency drugs was nine months.

Drugs for treating infections were the most common ones to run low, with 148 shortages. Painkillers and drugs for treating overdoses and poisonings were also among the most common shortages.

Hawley noted that a particularly problematic shortage was for nalaxone, the only injectable treatment for opiate overdose.

In nearly half of shortage incidents, the manufacturer did not give a reason for the shortage when contacted. For shortages with a known reason, about a quarter were due to manufacturing problems or delays, around 15 percent were caused by market supply and demand issues and about 4 percent were from problems with raw materials.

"Just imagine that a critically ill patient comes to the ER and needs to have specific medication. When we do not have this medication, it can lead to delays in treatment, or it could lead to suboptimal treatment," said Dr. Ali Pourmand, a professor of emergency medicine at George Washington University who was not involved in the new study.

Pourmand noted in an email that when doctors use substitute drugs they are less familiar with, there is a risk of medication error, and health care costs could increase as a result. Such errors could include issues with dosages or dangerous interactions between multiple drugs.

"Ultimately, a multifaceted approach involving regulators, manufacturers, providers, and other stakeholders will be required to address this growing public health problem," Pourmand said.

In 2013, the U.S. Food and Drug Administration released a plan to combat drug shortages (see Reuters story of Oct. 31, 2013, here: http://reut.rs/1PelXlb). Last spring, the agency also released a mobile app for doctors and pharmacists to search for information about drug shortages (see Reuters story of March 16, 2015, here: http://reut.rs/1SQQ2Nw).

Pourmand urges emergency departments to plan for shortages. "Current policy initiatives have had a limited effect on addressing drug shortages. Emergency Department providers must be aware of shortages and take an active role in mitigating their effects on patient care."

"While local and regional systems can collaborate to prepare for shortages and put protocols in place to protect patients to the best of their ability, the root cause of drug shortages should be aggressively explored at the national level by policymakers, manufacturers, physician-led organizations, and patient advocacy groups," Hawley said.