In an essay I encourage everyone to read in its entirety, Erin Blakemore wrote in the Washington
“Emergency rooms are health care’s front line — in the United States, nearly 45 out of 100 people visit an ER in any given year. But there’s an issue brewing behind the scenes in emergency medical facilities, one that can’t be fixed by a simple stitch or bandage. A new study published in the journal Academic Emergency Medicine shows that drug shortages in ERs across the United States increased by more than 400 percent between 2001 and 2014.
The study analyzed data from the University of Utah Drug Information Service, which receives drug shortage reports submitted through a public site administered by the American Society of Health-System Pharmacists. Two practicing emergency room physicians assessed whether the reported shortages had to do with drugs used in ERs, then looked at whether they were associated with lifesaving or acute conditions.
Of the nearly 1,800 drug shortages reported between 2001 and 2014, nearly 34 percent were used in emergency rooms. More than half (52.6 percent) of all reported shortages were of lifesaving drugs, and 10 percent of shortages affected drugs with no substitute. The most common drugs on shortage are used to treat infectious diseases, relieve pain, and treat patients who have been poisoned. Though the number of shortages fell between 2002 and 2007, they’ve risen by 435 percent between 2008 and 2014.”
Blakemore quotes Jessie Pines (Director of the Office for Clinical Practice Innovation at GWU:
“’that’s nothing less than a public health crisis… Shortages ‘are real, they’re happening, and they’re getting worse,’ he said.”
Where are the Drugs?
According to Blakemore, these shortages are the result of manufacturing delays, supply and demand imbalances and unavailability of key raw ingredients. Furthermore, some pharmaceutical companies cited “business decision” as one reason for production declines. This essentially translates into a rationale stated as “some drugs aren’t sufficiently profitable to bother manufacturing.” Blakemore notes that the majority of drugs on shortage in emergency rooms are sterile injectable medications with low profit margins, and thus not likely to stimulate more production from a profit motive.
Pharmaceutical companies claim that they should not be blamed for the shortfall in drug availability. The Pharmaceutical Research and Manufacturers of America (PhRMA), an industry group, points the finger at secondary wholesalers. “The manufacturer of a drug has no influence or control over the prices charged by a secondary wholesaler to a hospital or pharmacy,” the group said in a statement on its website. Supply chain issues and raw materials shortages can also play into shortages.
Secondary wholesalers claim that they should not be blamed from the shortfall in drug availability. The Healthcare Distribution Management Association, a wholesaler industry group, writes that “many factors” may result in product shortages and that they typically happen with “insufficient warning and often [require] significant time and resources to manage.”
So, drug supply chain disruptions, without any clear single cause or villain to blame, now threaten a major healthcare crisis in health care facility emergency departments across the nation. It is happening and there are apparently few (or no) easy and simple solutions. It is time for health care providers to figure out how to best deliver continuity of care despite these shortages.
“Take Aways” for the Rest of Us
Critical supply chain links exist in every market sector. Often, it is the very things that we take most for granted that are among the first things that “shock us” when they are no longer readily available.
Conducting supply chain reviews and assessing vulnerabilities should be done periodically. Business continuity planning should be ongoing and efforts to mitigate disruptive effects should be diligently pursued. For the rest of us, use this developing crisis as an important reminder to make due diligence towards readiness and preparedness.