Opioid Shortages

[banister]

Opioid shortages leave US hospitals scrambling - CNN

Does anyone else's hospital have this problem? We've been out of dilaudid for over a month now and are critically low on fentanyl, morphine, and ketamine. Many of us are moving onto IV methadone, demerol, alfentanil...

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[partydoc]

Opioid shortages leave US hospitals scrambling - CNN

Does anyone else's hospital have this problem? We've been out of dilaudid for over a month now and are critically low on fentanyl, morphine, and ketamine. Many of us are moving onto IV methadone, demerol, alfentanil...

Yup, same issues here

 

[Psai]

We run out of everything temporarily. LR, syringes, blades, etc.

 

[POW16]

Opioid shortages leave US hospitals scrambling - CNN

Does anyone else's hospital have this problem? We've been out of dilaudid for over a month now and are critically low on fentanyl, morphine, and ketamine. Many of us are moving onto IV methadone, demerol, alfentanil...

Same here. Methadone, Toradol, alfentanil, pre-op tylenol and gabapentin, regional when feasible are some of the options we are using.

 

[Robotic Wis-Hipple]

Um, didn’t you get the memo, opioids are bad, especially fentanyl, it’s in street drugs now.... I’m convinced a lot of this fentanyl/dilaudid shortage is reactionist propaganda driven. Though it could just be the run of the mill off patent, low profit margin, single manufacturer deciding their facilities are better used generating profit scenario.

If you had a factory that was making fentanyl for small gains would you continue making it in the current PR situation?

 

[deleted171991]

Same here. Methadone, Toradol, alfentanil, pre-op tylenol and gabapentin, regional when feasible are some of the options we are using.

Coming soon to a PACU near you: biting down on wood.

 

[partydoc]

Coming soon to a PACU near you: biting down on wood.

Willow bark, right?

 

[Psai]

Coming soon to a PACU near you: biting down on wood.

Wish all my patients had this kind of dentition

 

[Aether2000]

We are in a critical shortage of fentanyl but part of this is being generated by locational allocation- all our 2ml vials in the main OR were replaced with 5ml vials (we rarely use more than 1-2 ml per case, so we end up wasting most of each vial) and the heart rooms were given 2ml vials and all their 5ml vials were removed. So for hearts, they are opening 7-14 vials per case. I told the pharmacy director about this 2 1/2 weeks ago but there have been no changes......go figure.

 

[deleted763299]

How is everyone dosing methadone? What kinds of procedures are you using it for? Just curious, I've actually never used it in the OR

 

[anbuitachi]

We are in a critical shortage of fentanyl but part of this is being generated by locational allocation- all our 2ml vials in the main OR were replaced with 5ml vials (we rarely use more than 1-2 ml per case, so we end up wasting most of each vial) and the heart rooms were given 2ml vials and all their 5ml vials were removed. So for hearts, they are opening 7-14 vials per case. I told the pharmacy director about this 2 1/2 weeks ago but there have been no changes......go figure.

That makes no sense. Our heart rooms get 20ml fentanyl vials. General OR gets 2

 

[AdmiralChz]

That makes no sense. Our heart rooms get 20ml fentanyl vials. General OR gets 2

Damn haven’t seen 20 mL vials since October at least! Been replaced with 2s and (recently) 5s.

 

[IlDestriero]

How is everyone dosing methadone? What kinds of procedures are you using it for? Just curious, I've actually never used it in the OR

We use it for our spines and select other very painful procedures. 0.1 mg/kg max 10mg


--
Il Destriero

 

[facted]

How is everyone dosing methadone? What kinds of procedures are you using it for? Just curious, I've actually never used it in the OR

.1-.15 mg/kg, have gone up to 20mg. Very useful in bigger cases or opiod tolerant cases.

Dose it up front. Quick onset, about 10 minutes.

 

[Aether2000]

It would probably be easier if we just ordered carfentanil from China off the internet. I wonder if Amazon delivers to hospital ORs?

 

[AdmiralChz]

It would probably be easier if we just ordered carfentanil from China off the internet. I wonder if Amazon delivers to hospital ORs?

Only if they have Amazon Prime.

 

[partydoc]

How is everyone dosing methadone? What kinds of procedures are you using it for? Just curious, I've actually never used it in the OR

We have no IV methadone either

 

[deleted162650]

Too bad Silk Road is gone.

 

[Orin]

I think the methadone idea isn't too bad. It does look like the kinetics/atypical effects might be useful to reduce post-op opioid usage.

Use of Methadone in the Perioperative Period

Intraoperative methadone: Rediscovery, reappraisal, and reinvigoration?
"20 mg methadone as an IV bolus following induction of anesthesia"

You could probably get away with a pre-operative oral dosing as it is absorbed very well throughout the upper GI tract, although I would probably opt for a lower dose/conversion in the 15 - 30 mg PO rather than the 2:1 normally used for PO:IV.
Revisiting methadone: pharmacokinetics, pharmacodynamics and clinical indication
"It may be detected in the plasma 30 minutes after oral dose, and time to reach plasma peak concentration is 2.5h for oral solution and 3h for tablets"

 

[anbuitachi]

How long is that 10-20mg of methadone going to last?? when to redose? Why not give it to shorter cases? Wont it help with pacu pain control

 

[facted]

How long is that 10-20mg of methadone going to last?? when to redose? Why not give it to shorter cases? Wont it help with pacu pain control

Lasts about 48 hrs though pharm kinetics vary greatly. No need to redose intraop.

 

[epidural man]

I think all the drug shortages are from the Puerto Rico issues. Most our drugs are made there.

I lived in Manati for a while - you could smell the factories pouring crap into the air. They have much less stringent rules about the environment, so I assume that is while all the companies go there so they can dump their waste into the PR aquifer and into the caribbean air.

 

[Twiggidy]

.1-.15 mg/kg, have gone up to 20mg. Very useful in bigger cases or opiod tolerant cases.

Dose it up front. Quick onset, about 10 minutes.

probably would be pretty useful in a CV case....unless i'm getting my pharmacodynamics confused

 

[Twiggidy]

Lasts about 48 hrs though pharm kinetics vary greatly. No need to redose intraop.

there it is....i should've read the full thread first

 

[Ronin786]

This is a wonderful article about methadone usage.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689220/pdf/nihms472189.pdf

Severely underutilized drug. Lots of it due to fears of interactions with other meds post-op.