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Drug Shortages Q & A

ASHP InterSections recently spoke with drug shortages expert Erin R. Fox, Pharm.D., manager of the Drug Information Service at the University of Utah Hospitals & Clinics, Salt Lake City, to get her perspective on the current crisis. Here is what Erin had to say:

How would you compare the situation today to what it was five years ago?

The current situation is nothing short of a health care crisis. Recent survey data from the American Hospital Association show that almost half of all hospitals are experiencing a shortage on a daily basis. This is a huge increase from several years ago. What makes the current batch of shortages even more difficult is that these are chemotherapy products. In many cases, there are no alternatives. Patients are having their treatments delayed and may have their chance for a best outcome destroyed because of these shortages. Safety is also a huge concern for hospitals as they try to switch out high-risk electrolyte products. Several years ago, we had shortages, but not as many. We also didn’t have shortages of so many high-risk drugs.

I lose a lot of sleep over drug shortages these days. I talk to so many patients who can’t get their treatments as well as pharmacists who are worried about medication errors due to the high rate of shortages. It is an absolute nightmare for both patients and health systems.

What are some of the overarching reasons for the shortages you’re witnessing?

It is incredibly difficult to point to just one reason for shortages. There are so many unknowns and areas to be explored. If you want to put it simply, though, we have few manufacturers making sterile injectable drugs. In many cases, there are just one or two companies making a drug that every hospital needs every day to take care of their patients. When multiple manufacturers have problems at the same time—whether it’s trouble getting raw materials that they are working through a manufacturing issue—it is a recipe for disaster. There is no resiliency in our supply chain to handle even a short-term manufacturing outage. Manufacturers can’t make up even 20 percent of another company’s market share. 

Is your drug information service experiencing an uptick in call volume due to this issue?

The call volume at our center hasn’t necessarily increased, but we have seen a huge increase in the work we do on shortages. We used to get 10 reports of new shortages a week. Now, we sometimes receive 10 reports in a day. We also used to provide updates for 15 to 30 shortages per week. Now, that number has tripled and is routinely in the 90s. I have the most amazing staff members who have adjusted to this increased workload magnificently. I am so glad to work with such a dedicated and talented team. Everyone should know that the information posted on ASHP’s Drug Shortages Resource Center is possible through the work of the staff at the University of Utah Drug Information Service.