Undersupply of Opioids: A Growing Issue in US Hospitals
Key Takeaways:
- US hospitals face a significant shortage of key injectable opioids and anesthesia drugs, impacting 98 percent of anesthesiologists’ patient treatment methods.
- Commonly unavailable drugs include hydromorphone, fentanyl, morphine, bupivacaine, and epinephrine, hampering surgery and post-surgery procedures.
- The shortages originate from production issues at a major pharmaceutical manufacturer’s facility and US government measures to reduce available opioid components.
- Among the fallback solutions that medical practitioners resort to are older drugs with severe side effects and oral opioids that have delayed onset, which adversely affect patient satisfaction and treatment results.
- Proposed remedies for the crisis include faster introduction of generics to the market, preventive strategies and early detection systems for drug shortages, and enabling foreign drug companies to supply to US hospitals during significant scarcities.
In a concerning development, American hospitals face a rising deficiency of injectable opioids and anesthesia drugs, crucial to surgery patients during and post-procedures, as unveiled by a recent analysis.
An overwhelming 98 percent of the anesthesiologists who took part claimed they frequently encounter such deficiencies.
The federal government’s recent steps to mitigate the opioid dilemma – by scaling back on the essential components used in manufacturing these opioids – may provide some reasoning for this phenomenon.
In a dismal revelation, 95 percent of participants stated that these shortages have impacted their methods of patient treatment.
The Drugs in Scarcest Supply
The top five drugs facing the severest shortage include opioids like hydromorphone, fentanyl, and morphine, the local analgesic bupivacaine, and the critical allergy medication epinephrine, as identified by the American Society of Anesthesiologists’ study.
“Practitioners are exasperated as they’re striving to deliver exceptional healthcare but are hampered by supply restrictions,” expressed ASA President Dr. James Grant.
Particularly worrisome is the dearth of the local analgesic bupivacaine, often preferred to alleviate the pain endured by expectant mothers during a C-section delivery while keeping them conscious, added Grant.
“We possess very scarce quantities and we’re dispensing it prudently. This situation is unprecedented for us,” shared Grant of the bupivacaine scenario.
Origins of the Shortages
The shortages partly originated from production hindrances at a Kansas-based manufacturing facility, acquried by pharmaceutical firm Pfizer in its 2015 takeover of competitor Hospira.
“Post-acquisition, Pfizer identified several production quality issues. Instead of progressively shutting down the factory to enhance its standards, they abruptly halted all operations,” explained Grant.
As of a customer letter from November 2017, Pfizer has stated that full-scale production isn’t expected to resume at the establishment until early 2019.
Further Complications
While other drug companies have attempted to bridge the gap, they have faced challenges due to the U.S. Drug Enforcement Administration’s (DEA) measures to curtail the availability of prescription opioids by reducing the raw materials used for painkillers.
Despite the DEA’s recent policy shift in response to complaints about the depleting opioid supply required for pain management in hospitals, drug manufacturers still face the struggle.
Anesthesiologists are contending with providing adequate patient care amid these constraints. Using older drugs with severe side effects is one of the fallback measures, with serious implications for patient satisfaction, quality, and performance – as per a study participant.
Alternatives like oral opioids are subpar for surgical patients because of delayed onset.
“Following major surgeries, patients are in distress due to the absence of rapidly-acting medications,” observed another anesthesiologist.
Focus on Remedying the Situation
With the crisis in full swing, the priority is to surpass this challenge with optimism for instituting reforms to evade such shortages in the future, according to Grant.
These reforms could encompass faster introduction of generics to the market, establishing reserve strategies and surveillance systems to predict and prevent imminent drug scarcities, and facilitating foreign drug companies to provide to US hospitals during critical shortages.
“We’re discovering alternatives, although they may not be our first preference. Our quest is to do all we can for patients,” asseverated Grant.
