The last thing you want to think about when you go to the emergency room is that it is fresh out of the drugs you might need — for whatever illness or injury brought you there in the first place.

But that is exactly what’s happening right now. A shortage of acute care drugs across the U.S. is creating challenges for physicians, as well as standing in the way of top-quality care.

Dr. Arjun Venkatesh, an assistant professor of emergency medicine at the Yale School of Medicine, recently published a study in Health Affairs on this topic. He noted an increasing shortage of drugs essential for emergency care — pain medication, sedatives, heart drugs, even saline and electrolyte products.

Even more troublesome: There are few systems in place to help hospitals anticipate production deficiencies. When there is a shortage, doctors quickly focus on finding a substitute medication — yet in some cases, a substitute doesn’t exist.

Venkatesh’s team examined data on confirmed national drug shortages during the years 2001 to 2014. Of 1,929 shortages reported during that time period, 52 percent were for acute care drugs. Half of the acute care drug shortages lasted longer than 242 days — while specialty drug shortages lasted 173 days.

Emergency departments typically rely on injectable drugs more than others — and 70 percent of scarce drugs were injectables.

“Acute care drug shortages are getting more frequent,” Venkatesh told LifeZette.

[lz_ndn video=30669797]

Dr. Jesse Pines, an emergency medicine professor at George Washington University School of Medicine and Health Sciences in Washington, D.C., studied drug shortages from 2008 to 2014. He found that the number of shortages in emergency departments alone rose by 435 percent. Most unavailable drugs were the type needed for saving lives.

“We’re currently in a public health crisis with rising drug shortages, and the most concerning thing is that it’s likely to only get worse,” Pines said in a statement. “It is very concerning if there is a life-saving medication for a condition, but it’s just not available.”

Who do you think would win the Presidency?

By completing the poll, you agree to receive emails from LifeZette, occasional offers from our partners and that you've read and agree to our privacy policy and legal statement.

Low Profit Margins
Venkatesh said that there are two main reasons for deficiencies in acute care drug supplies. Generic injectables have low profit margins — and manufacturers focus their production efforts on drugs that will make them more money.

[lz_bulleted_list title=”Behind the Drug Shortages” source=”http://www.ashp.org”]Manufacturing problems: 22%|Supply/demand: 12%|Regulatory: 3%|Discontinued: 6%|Unknown: 57%[/lz_bulleted_list]

Even though some life-saving generics can be relatively cheap to buy, they are also harder to make and require stringent manufacturing conditions.

Renee Petzel Gimbar, an emergency medicine clinical pharmacist at the University of Illinois Hospital & Health Sciences System, said the Food and Drug Administration is doing a good job of ensuring drug safety. If a manufacturer isn’t up to par and the facility is shut down, however, it depletes supplies.

“On the one hand, we want regulation of medication,” she explained. “But then that also creates situations where you’re going to see shortages.”

New Normal
At his hospital in Connecticut, Venkatesh said electronic health records show an alert when a drug is in short supply. Sometimes an alternative drug is suggested, which may cost more or cause different side effects.

However, if a patient needs magnesium, there’s no alternative. Then doctors have to ask if the patient is sick enough to need it — which puts the medical team in a bind, he said.

A 2014 study from Northwestern Medicine together with MedAssets, part of the MedAssets Pharmacy Coalition, looked at survey reports and found that nearly half of respondents said there had been adverse events at their facilities due to drug shortages — including deaths.

[lz_related_box id=”70544″]

Petzel Gimbar’s facility has faced shortages before, and says hospitals are essentially on their own to procure drugs in a very haphazard manner, which creates more scarcities.

“Everybody’s trying to kind of hoard things, essentially,” she said.

One time her facility was low on epinephrine — it’s stocked in every crash cart, and there’s no alternative for it. Doctors had to choose which patients needed it most and would therefore receive the medication.

“We certainly were trying to ration it as best as we could,” recalled Petzel Gimbar, who said shortages force health providers to scramble and make off-the-cuff, real-time decisions.

Venkatesh said he sees issues with acute care drug shortages on just about every shift.

“You never know which drug is going to be on shortage and when that shortage is going to be,” he said. It is “remarkably frustrating and challenging.”

“It’s become the norm, unfortunately,” Petzel Gimbar said. “It sounds awful, but it’s something we’ve just gotten used to.”

“Coming out of pharmacy school, if you would have told me we were going to face shortages like this, I would have laughed in your face,” she added.

Seeking Solutions
The FDA passed the Safety and Innovation Act of 2012, which created some parameters to respond to drug shortages. It helped limit the shortages of specialty drug shortages, but not acute care drugs.

Venkatesh said hospitals are required to report shortages. But there is no way to anticipate a shortage or receive notifications that would allow facilities to better coordinate resources. There’s no infrastructure in place for it, he said.

“The data is there,” Venkatesh noted. “It exists. It’s just not currently set up to be collected.” He added, “Right now we are set up in a way where we only figure out the problem after it’s a big problem.”