Recently, I was caring for a middle-aged man who presented to the cardiology service with chest pain that turned out to be a heart attack. Because the gentleman had been a kidney transplant recipient, we consulted a renal transplant specialist who recommended acetylcysteine (Mucomyst) as premedication prior to cardiac catheterization. Mucomyst binds the contrast load to protect the kidneys.
After several attempts to order the medication, however, it became obvious that the drug wasn’t in the system. I called the pharmacy and they explained that there was a national shortage of Mucomyst and that I wouldn’t be able to order this drug for my patient.
I was dumbfounded. How could a great institution be short on such an important medication?
As it turns out, the United States is experiencing shortages of several medications. In a recent survey of 820 hospitals, the American Hospital Association found that nearly half of the institutions had experienced shortages of 21 or more drugs within the last six months.
At my own institution, another serious drug shortage involves vasopressors. There are four major types of pressors, and each one has its own unique properties that make me want to use one over another. However, because of shortage issues there have been times when the preferred pressor is not available, and I’ve had to use another.
Another drug, doxorubicin (Doxil), an important anticancer medication, also is in short supply, but tumors won’t wait to grow until cancer patients receive the medication.
This inability to give critically ill patients the most appropriate medications reminds me of a time when I was working in a hospital in rural India. A patient was experiencing a lower GI bleed, and we needed an endoscopy suite to identify the source, but we were unable to locate one in time.
Part of the problem is that some drug manufacturing plants have had to halt production because of contaminants in their products. Many of these factories are located in developing countries, and their inspection processes are not as rigorous as in the United States.
Bills before Congress aim to address the shortages by requiring manufacturers to give the Food and Drug Administration a heads up six months in advance of an expected shortage. Other proposals attempt to head off shortages by building national stockpiles of critically needed drugs and by creating incentives for manufactures to produce an adequate supply of generic medications, according to The New York Times.
The U.S. Centers for Disease Control and Prevention already has a plan in place to stockpile certain drugs that would be needed in the event of biochemical warfare or disease epidemics.
But in the meantime, I’m concerned about the dwindling supply of drugs that are a crucial part of care for many of my patients in the hospital today.