National Drug Shortage Hits ENT Surgeries: Succinylcholine, propofol and tetracaine in limited supply

And hospitals, physicians and pharmacists never know what’s coming next. “Neostigmine, a drug we use to reverse the effects of certain muscle relaxants, went short a couple of weeks ago,” Dr. Gonzalez said. “We were told at 4 p.m. on one day that we’d run out the next day, so we had to scramble to find options. There is another drug we can use [Enlon-Plus], which is as good but pretty expensive, so we hadn’t used it for decades. They were able to get it in, but then I had to in-service 115 people overnight on how to use this drug, because none of them had used it in 10 years.”

Solutions

There’s no one culprit; rather, a confluence of factors seems to be behind the sudden medication supply crisis. Many of the drugs running short are generics, which offer no real incentive for a manufacturer to get into the game, so there may be only a handful of suppliers—or even just one. When one supplier shuts down production temporarily, perhaps because of contamination in the supply chain, or due to a shortage of raw materials, the other suppliers, if any, may be hard pressed to ramp up production in time, Vaida says.

Meanwhile, about 80 percent of the raw materials for many drugs come from overseas at a time when there is a great deal of unrest going on. The economic downturn of 2008-2009 also played a role, putting pressure on companies to quickly shut down product lines should they become less profitable. “All of these factors have come to a head at the same time,” Vaida said.

So what can be done? According to ASHP, the American Society of Anesthesiologists (ASA) and the American Society of Clinical Oncology (ASCO), drug manufacturers should be required to notify the FDA ahead of time when they anticipate a slowdown or an interruption in the supply of a certain drug. Right now, manufacturers usually don’t have to give any early warning of an impending shortage.

If you learn of a shortage, ASHP wants to know about it. Bona Benjamin, ASHP’s director of medication-use quality improvement said to report shortages at ashp.org/shortages. “It’s not restricted; anyone can report a shortage if they know that one is pending,” she said. “We can make sure that the FDA knows about it. They’ve told us that sometimes our notifications have been their first alert to a shortage. This gives them more latitude to get plans in place.”