Nebraska pharmacies waiting for remedy on drug shortages

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November 28, 2011 - 6:00pm

Drug shortages in the U.S. are reaching unprecedented levels. So far in 2011, more than 200 different medications have been in shortage. The Food and Drug Administration maintains a revolving list of dozens of drugs that are in short supply. While President Obama has issued an executive order to try to remedy the situation, several medications continue to be hard to find in pharmacies across the country and in Nebraska. Grant Gerlock of NET News went to the Nebraska Methodist Hospital in Omaha to talk to Matthew Hornig, drug purchaser, and Kevin Borcher, pharmacy informatics coordinator, about the impact of drug shortages.

Photo by Grant Gerlock, NET News

Matthew Hornig and Kevin Borcher at Nebraska Methodist Hospital in Omaha. Drug shortages have made it hard to locate some critical medications.

KEVIN BORCHER, pharmacy informatics coordinator: We have a medication carousel that holds virtually all of our medications for storage and retrieval. We bar code anything that goes in or out to ensure that we're supplying the right drug up to the nursing staff for the patient.

GERLOCK: So this is where you come to get the actual medication. if you have a shortage, this is where it will show up.

BORCHER: This is where it won't be. Yes.

GERLOCK: Have you ever seen a situation quite like you've been seeing?

BORCHER: No this seems to be the worst that I've ever seen it. It keeps getting worse and worse every month.

GERLOCK: So the drugs that are coming up short, are they drugs that are used rarely or are we seeing stuff that is very common?

BORCHER: We're seeing common drugs now. Some are very common. One I can think of is naloxone, which is used for opiate or morphine overdoses. We've had dextrose, morphine, fentanyl, lidocaine

MATTHEW HORNIG, drug purchaser: Lidocaine, which you would think is very common.

BORCHER: It's a topical analgesic. Painkiller.

GERLOCK: These are common drugs and you're finding out that supplies are drying up and they're hard to find.

HORNIG: Yeah, we'll have our standard size that we normally use and we have to look for alternatives. Say we normally use a 10 mL vial. Well, now we're swapping out to 20 mL or 50 mL vials. But most of the time we're going the other way. We're having to find smaller ones, which creates more work for us, and it changes processes around the pharmacy when we have to shift gears like that.

GERLOCK: Are the shortages you're running into the same that are happening all across the country?

BORCHER: They seem to be pretty consistent throughout, yes.

HORNIG: I know - we've worked with a facility in Vanderbilt University. We've contacted them back and forth. They were looking for something was a regional shortage. And we said, oh, you guys can get this, we can get this. Let's try to come to some agreement. There are some regional (shortages), but it's mainly national.

GERLOCK: What are some of the most urgent shortages that have come up here?

HORNIG: Morphine and fentanyl right now have been probably the most impactful for us. That with heparin, the heparin bags that we use...

BORCHER: Heparin is an anti-coagulant used for patients who may have a pulmonary embolism, a deep vein thrombosis, other type of bleeding or clotting disorders.

GERLOCK: So this is an urgent drug that you need to apply immediately if there's a situation?

BORCHER: This is a life-saving drug that we've been struggling to get.

GERLOCK: So what's causing all these shortages? It's a lot of different drugs. Why are they coming up short?

BORCHER: There are probably a handful of reasons: either a shortage of raw material, either manufacturing issues - that the FDA may restrict or shut down certain manufacturing plants. Or it could be that the manufacturer itself finds the drug non-profitable and they'll discontinue manufacturing it.

HORNIG: When we hear of a shortage coming, a lot of hospitals throughout the nation will see what's available and they'll buy everything that's available, making the shortage worse. A little bit of hoarding going on.

GERLOCK: So when drug supplies come up, what do you do? How do you fix it?

BORCHER: We get very creative sometimes. We try to use available resources. Contacting manufacturers directly. Contacting other facilities in the area to see if there's any type of borrowing or sharing that we can use.

GERLOCK: You have to find other drugs that might do the same thing? Is that always possible?

BORCHER: It's not always possible. We try to find something in a different size for the same drug. If we can't do that we'll look for a different drug in the same therapeutic class that might work similarly. If we can't do that, then our creativity increases and we may even have to work with the medical staff to allocate or restrict that use to only specific indications.

HORNIG: Acetylcysteine was being used for respiratory and GI things. But we decided when it went on shortage that it had to be used for Tylenol overdoses only. I ended up calling Poison Control to find out how many overdoses were in the city of Omaha in the last year. Found out from our administration how many came here. Then we found we have to have this level of acetylcysteine, this many vials to have this many patients that would come through. We took that to the medical staff and said this is going to be restricted for this only. That did change some of the practices on the floors and throughout the hospital.

GERLOCK: And if there's not enough of one drug and you have to switch to something else that also does the job, do you start to run out of that one?

BORCHER: We start to create a domino effect, or a cascade effect, because then that similar drug becomes a shortage. That manufacturer wasn't planning on the volume of usage that they're selling. And that cascades to cause another shortage with that drug. It also affects, with supply and demand, the prices. Where on some drugs we were able to get a very reasonable price, possibly on contract. And now we're having to pay a premium for that drug, sometimes 10 to 100 times more than what the original drug (cost) was.

GERLOCK: That does crazy things to your usual budget then?

BORCHER: Our budget gets stressed when things like that happen. And we don't have any choice if we want that drug for patient care.

GERLOCK: What are your thoughts on how these shortages can be fixed or handled better? Is the situation likely to improve anytime soon?

HORNIG: I think this is kind of the way it's going to be for a while, unfortunately. There's really no good solution. You can try to fine companies for not notifying about upcoming shortages, but is that really going to make a change? We don't know.

BORCHER: I think if we have more notification, that can allow the hospitals to plan to either have a supply sufficient enough until that shortage is going to be over with or plan for other similar drugs to replace that drug on a temporary or permanent basis.

GERLOCK: Just having more time to plan that out.

BORCHER: More time would help.



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