Newspaper article International New York Times

How Less-Expensive Drugs Can Bring about Shortages

Newspaper article International New York Times

How Less-Expensive Drugs Can Bring about Shortages

Article excerpt

For some of the most important drugs, the prices may be too low, giving rise to shortages.

For some of the most important drugs, prices may be too low.

You hear a lot about high drug prices. You hear politicians calling for lower drug prices. But you may not be hearing about how low prices contribute to drug shortages.

The drugs most prone to shortage are generic injectable ones, administered to patients in the hospital or a doctor's office. They include anticancer agents, heart attack medications and anesthetics, many used in life-threatening, emergency situations. When such drugs are in short supply, they cause dangerous delays in care as hospitals seek alternatives. Even when good substitutes can be found -- and sometimes they cannot -- they may be less familiar to doctors, come with different side effects or not work as well, all of which pose risk to patients.

For example, when morphine is in short supply, doctors might switch to hydromorphone, an alternative opiate painkiller. Hydromorphone is seven times more powerful than morphine. Failing to account for that difference can kill. In 2011, during a morphine shortage, two fatalities were linked to the accidental dosing of hydromorphone as if it were morphine. This year, the generic injectable form of nitroglycerin -- used to treat serious heart attacks in emergency departments -- is among the drugs in shortage, prompting the Food and Drug Administration to seek additional supplies overseas.

Hospital pharmacists say drug shortages are their biggest problem. "Clinicians are spending time making sure patients aren't impacted by drug shortages," said Erin Fox, a pharmacist and director of the University of Utah's Drug Information Service, which tracks drug shortages. "But it's incredibly frustrating to not have access to basic essentials."

The number of drugs in short supply peaked in 2014 at 320, the vast majority of which were generic injectables. That doesn't mean the problem has faded. According to a recent study in the journal Health Affairs by Ms. Fox and colleagues, the number of emergency and critical care drugs in short supply has grown in recent years. These include pain medications, sedatives, electrolyte solutions, antibiotics, antidotes and drugs that undo the effects of anesthesia.

According to another recent study by Ms. Fox and colleagues, one- third of drugs in short supply are used in emergency departments to treat critical health problems like respiratory distress, heart problems and overdoses. Half of drugs used by emergency physicians that are in short supply are for life-threatening conditions, and 10 percent have no good substitutes. Such supply disruptions are not brief -- most last at least nine months, according to the study -- so they affect many patients.

Generic injectables are prone to shortage because of low profit margins and high production costs. …

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