<img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=192888919167017&amp;ev=PageView&amp;noscript=1">
Friday, March 29, 2024
March 29, 2024

Linkedin Pinterest

Hospitals grapple with drug shortage

Southwest, Legacy have not yet run out of crucial supplies

The Columbian
Published: February 23, 2011, 12:00am

A nationwide shortage of key drugs has forced local hospitals to get creative in their treatments of some diseases, including cancer.

“We haven’t run out of anything crucial,” said Becky Caswell, assistant director of pharmacy at Southwest Washington Medical Center.

But the hospital has had to ration, opt for more expensive alternatives to preferred drugs, and work carefully to plan cancer treatments and surgeries with doctors.

Drugmakers say the shortage is the result of tougher federal safety rules, which have prompted them to review manufacturing processes and take some drugs off the market. Consolidation and competitive pressures within the pharmaceutical industry have exacerbated the shortage.

The result: area hospitals have become increasingly vigilant over their use of medication, as they watch to make sure that essential drugs don’t run out.

So far, that has not happened, said Kathy Stoner, pharmacy services director for Legacy Health, which operates Legacy Salmon Creek in Vancouver. But doctors and nurses have been forced to use second-choice medications.

For example, when a preferred anti-convulsant became scarce, Legacy began to use another effective treatment — phenytoin — that can cause tissue damage when it escapes from an intravenous tube.

“We have nurses who weren’t practicing last time phenytoin was in use,” Stoner said. “There was some education needed about the right dose for the drug and how to give it so it’s safe for patients.”

When shortages spur a substitution, patients usually do not even know there was another option.

While local hospital officials say they are unaware of postponed or canceled treatment linked to unavailable drugs, vaccine shortages have affected preventive health. Southwest Washington Medical Center has not had the shingles vaccine in stock since December, and does not expect the next order to arrive until June — despite six pending prescriptions from patients who would like the shot.

Part of the shortage is being caused by manufacturing issues and quality-control problems at a number of companies as they respond to the federal government’s crackdown on drug safety. The quality issues can range from finding toxins and “particulate matter” in medicines to workers inaccurately filling out the required paperwork to verify that the drugs, as well as the devices used to intravenously deliver the products to patients, are safe and effective.

Even after a company restarts production of a drug, it takes time for a plant to catch up to the back orders. And injectable drugs in particular, unlike pills and tablets, tend to require long lead times to produce.

There are about 150 drugs — triple the number from just five years ago — that are in short supply, according to the American Society of Health-System Pharmacists, a trade group that works with hospital pharmacists on ways to deal with the shortage. About 60 of those are considered by federal health officials as “medically necessary,” and they include prescription medicines used to treat or prevent a serious disease or medical condition.

Challenging climate

Legacy Salmon Creek has experienced difficulties in obtaining about 75 drugs that it has ordered over the past year.

It’s a challenge to know which drugs will be available, despite industry efforts to publicize supply problems.

“Sometimes we find out when we go to order something, sometimes we know sooner,” said Caswell of Southwest Washington Medical Center. Several times the hospital has had to implement immediate changes to its formulary, or guide to preferred drugs.

Changing a formulary can be a complex process because it requires communication among doctors, nurses and pharmacists.

Drugmakers say they are obeying tougher safety rules put in place by the U.S. Food and Drug Administration, which has intensified scrutiny to avoid allowing unsafe medicines on the market. The FDA came under fire for its role in monitoring the blockbuster pain pill Vioxx, which was pulled off the market in 2004 by its manufacturer, Merck & Co., after the drug was linked to heart attacks and strokes.

The drug shortage is being exacerbated by consolidation in the pharmaceutical industry, which leaves fewer companies making drugs.

In addition, some drug companies have exited the business of making older, generic injectable drugs, which typically aren’t as profitable as newer brand-name medicines. That puts additional production pressure on the remaining makers of these generic treatments.

Take propofol, a popular anesthetic for surgeries and other medical procedures. Teva Pharmaceuticals Ltd. decided to exit the propofol business last year following a quality issue with the drug in 2009. In a statement, the company said it believed its “existing, approved technology is not suitable to ensure that we can consistently produce the product to Teva’s high quality standard.”

Teva’s decision came around the time another propofol maker, Hospira, had to stop shipping the drug due to quality issues in its production process. Last summer, the FDA allowed Hospira to begin production again. But the company said it needed time to ramp up production and fill back orders.

Teva also makes generic forms of certain cancer medications. When quality issues temporarily closed its plant in Irvine, Calif., in April, medical professionals were faced with limited supplies of an array of cancer drugs.

The drug shortages have gained the attention of members of Congress. Earlier this month, Sens. Amy Klobuchar, D-Minn., and Bob Casey, D-Pa., introduced legislation that would require drugmakers to give the FDA an early notification “when a factor arises that may result in a shortage,” according to a joint statement.

“Several major hospitals in our state have experienced shortages that are jeopardizing patient care, and this bill will provide the knowledge required to help address and prevent future shortages,” Casey said. “Knowledge is one of the most important tools for combating problems associated with drug shortages, which are a growing threat to public health in Pennsylvania and across the U.S.”

Hospitals are finding ways to deal with the lack of availability.

Legacy, which has five hospital campuses and a number of clinics, has moved products in short supply from one hospital to another, Stoner said. The hospital has also ordered some medications direct from the manufacturer at greater price than buying through a wholesaler, in order to guarantee shipment.

Turning to secondary suppliers when a primary source for drugs runs out has caused some hospitals to pay double or more for certain drugs.

In Illinois, Advocate Health Care pharmacists had to buy certain dosages of the drug neostigmine, used to reverse the effects of “paralyzing agents” commonly used in surgeries, for $11.50 per vial compared with the usual price of $1.50 to $6.50 per vial from their primary wholesaler, which ran out of the medicine.

Escalating prices are of major concern for those watching the nation’s ever-rising cost of health care, but pharmacists say they’re just relieved that so far their ability to offer treatments has not been substantially altered.

“I’m not worried at this time,” Caswell said, “but you never know.”

Loading...