Pharmaceutical Shortages

[pharmschooler]

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I know I'm just a pre-pharm here, but I've been reading about pharmaceutical shortages a lot recently in the news (most recently, a big Washington Post article: http://www.washingtonpost.com/natio...?fb_ref=NetworkNews&fb_source=profile_oneline)

I saw some old postings on this subject, but not much that talked about the actual role of pharmacists in helping solve these problems, outside of drug substitution. What, if anything, can pharmacists and pharmacy as a profession do to help? From the outside, it seems like pharmacy isn't contributing much to the discussion currently; perhaps it isn't part of the job of a pharmacist, strictly speaking. Still, it seems like there would be some agreement on ways to solve these problems from pharmacy, as an establishment. Am I unaware of something pharmacists are already doing to help?

If pharmacists are unable to obtain the meds people need, it could bring the credibility of the profession down, so it seems pharmacists would have a vested interest in improving the situation. Not to mention, the availability of important drugs like cancer medications can save lives...

I know these shortages exist for multiple, complex reasons outside the control of individual pharmacists (for example, the nuclear reactor in Canada that was shut down), but it seems that there could be some leadership from within the profession to help solve some of the problems.

 

[rxlea]

I don't know how pharmacists would "solve" the problem of drug shortages since the shortage is coming from the manufacturers...

We have been obtaining our cytarabine and foscarnet (and other drugs) from overseas. Cytarabine has been rationed and this isn't good considering it's role in AML tx. We have been getting AML patients from other institutions that were unable to obtain cytarabine. There are quite a few other drugs I have noticed with a "don't loan out" sticker on the bin. I only work weekends though, so I usually hear about all of this stuff after the fact...

The worst was the morphine injection shortage... THAT was a nightmare for multiple reasons.

 

[Praziquantel86]

The fundamental issue doesn't lie with pharmacists, it's the manufacturers. A lot of the drugs that go on shortage are because they're low-priced generics that generate little profit for the manufacturers. Without an incentive to keep them on the market (re: money), they don't manufacture them.

In regards to pharmacists doing something to alleviate the shortage, they are. ASHP has issued joint statements with the American Society of Anesthesiologists, who are disproportionately affected by these shortages, and some other organizations (who exactly is escaping me right now), asking the FDA to figure out a solution. It will take financial incentives, because the government can't force anyone to do anything.

You're right though, it is a big problem. Well over half the drugs routinely used in the perioperative period have been on longterm backorder, if not outright discontinued, over the last few years. Combining this with a lot of salvage antibiotics and chemotherapy, and you have yourself a big problem.

 

[lauradiddle]

If you haven't already, y'all should also check out the link in the article that goes over the incidents that have happened. Some of it is pretty scary. The incident where a nurse confused herapin with vanc definitely happened at my hospital. Compounded heparin and vanc bags do look similar, but we do put "high alert" stickers on the heparin bags. And, you know, the label says "heparin" instead of "vancomycin"...

I have to give our management a lot of credit for figuring out ways around the shortages, considering it takes up a huge chunk of our formulary now. I think the biggest for us so far was when we stopped getting Levophed.

 

[WVUPharm2007]

I'm looking forward to here in about 2 weeks when nobody on the East Coast has any methylpred 4mg tabs left after they already used up all of the Medrol dose packs...it'll be an epic pain in the ass.

 

[SomeGuy]

The FDA could help by easily allowing special imports of foreign products that are approved in countries with substantially similar regulatory regimes for drugs when required.

I think there's less risk in using a Canadian-licensed or UK-licensed product than changing to an unfamiliar, 2nd-line or just plain different drug. I have a feeling that a lot of the sterile product production is very centralized around the world anyway.

 

[schamj01]

I'm looking forward to here in about 2 weeks when nobody on the East Coast has any methylpred 4mg tabs left after they already used up all of the Medrol dose packs...it'll be an epic pain in the ass.

Yep, no methylpred 4mg tabs over here in the Midwest. And it does suck!