Drug shortages: Limited warnings, followed by rationing and hoarding

March 27, 2019

Despite ongoing efforts to develop efficient, practical and ethical allocation systems for medication shortages, a national survey found that 81 percent of hospital pharmacy managers had experienced medication hoarding. All of the pharmacy managers reported drug shortages in the previous year. More than two-thirds reported "more than 50 shortages."

In their research letter published in the March 25, 2019 issue of JAMA Internal Medicine, a team of ethicists, cancer specialists and a pharmacist presented the results of their survey. Their goal was to determine how common drug shortages were, which hospitals faced the greatest burden, and how hospitals planned for and managed drug scarcity.

The authors launched their survey to investigate how U.S. hospitals deal with the current challenges of drug allocation during shortages. They sent a 19-item questionnaire to 1,100 pharmacy practice managers and pharmacy leaders who are members of the American Society of Health System Pharmacists. Sixty-five percent, or 719 people, responded.

"All responders reported drug shortages in the preceding year," said Andrew Hantel, MD, corresponding author of the study and a hematology/oncology and medical ethics fellow at the University of Chicago Medicine. Almost 500 pharmacy practice managers (about 70 percent) reported more than 50 shortages. Most respondents stated that they had less than a month between hearing a medication was scarce and having a shortage at their hospital.

"In order to create a survey with questions that were relevant to our respondents, we conducted semi-structured interviews beforehand to understand pharmacists' experiences with drug shortages," Hantel said. "We analyzed this qualitative data systematically and tested questions for clarity and consistency before sending out the survey."

One out of three pharmacists surveyed reported that their hospital had no valid administrative mechanism to help them respond to a shortage. "More than 80 percent reported hoarding medications in response to shortages," Hantel said.

They found that at least one episode of rationing had occurred in the past year at more than one third of hospitals. This was more common at academic hospitals and their affiliates than at community hospitals.

Such shortages are distressingly common. The American Society for Hospital Pharmacists (ASHP) maintains a running list. Currently, 226 drugs, ranging from abciximab injection to yellow fever vaccine, are in short supply. The maker of abciximab (ReoPro®), a drug used to prevent cardiac ischemic complications, "cannot guarantee supply continuity." There are no other suppliers. The supplier of yellow fever vaccine points to "production delays." Again, there is no backup source for the drug.

In severe cases, the authors note, shortages require clinicians to decide "which patients receive needed medications and which patients do not, which can lead to rationing drugs between patients." Disclosing rationing to patients, the authors note, "was not common."

"Our survey," Hantel added, "suggests that more systematic approaches are needed to address the problem and decrease the need for rationing.
The University of Chicago institutional review board approved the study. Participating pharmacy managers provided written consent and were not compensated. Additional authors are Mark Siegler, MD; Fay Hlubocky, PhD; Kevin Colgan, PharmD; and Christopher Daugherty, MD, from the University of Chicago Medicine.

University of Chicago Medical Center

Related Medication Articles from Brightsurf:

New medication may treat underlying causes of hypertrophic cardiomyopathy
Mavacamten, a new investigational cardiac medication, may improve heart function for people with thickened heart muscle leading to obstructed blood flow through the heart, a condition known as obstructive hypertrophic cardiomyopathy.

Therapy plus medication better than medication alone in bipolar disorder
A review of 39 randomized clinical trials by scientists from UCLA and their colleagues from other institutions has found that combining the use medication with psychoeducational therapy is more effective at preventing a recurrence of illness in people with bipolar disorder than medication alone.

Kids diagnosed with ADHD often don't take medication regularly
Children diagnosed with ADHD inconsistently take their prescribed medication, going without treatment 40 per cent of the time, a new study has found.

Long-term medication for schizophrenia is safe
Researchers at Karolinska Institutet in Sweden and their colleagues in Germany, the USA and Finland have studied the safety of very long-term antipsychotic therapy for schizophrenia.

Which is more effective for treating PTSD: Medication, or psychotherapy?
A systematic review and meta-analysis led by Jeffrey Sonis, MD, MPH, of the University of North Carolina School of Medicine, finds there is insufficient evidence at present to answer that question.

ADHD medication: How much is too much for a hyperactive child?
When children with ADHD don't respond well to Methylphenidate (MPH, also known as Ritalin) doctors often increase the dose.

Pain medication use by children after common surgeries
About 400 caregivers reported pain medication use by children after common surgeries such as hernia, elbow fracture, appendectomy or adenoid removal in this study.

Bringing cancer medication safely to its destination
Treating cancer more selectively and more effectively -- this could be achieved with an innovative technology developed by teams of researchers at the Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP) and the Ludwig-Maximilians-Universität München (LMU).

Bullying linked to student's pain medication use
In a school-based survey study of all students in grades 6, 8, and 10 in Iceland, the use of pain medications was significantly higher among bullied students even when controlling for the amount of pain they felt, as well as age, gender, and socioeconomic status.

New medication gives mice bigger muscles
Researchers from Aarhus University, Denmark, have studied a new group of medicinal products which increase the muscle- and bone mass of mice over a few weeks.

Read More: Medication News and Medication Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.