Critical U.S. drug shortage worsening

The nation is facing an unprecedented drug shortage.

From cancer treatments to surgical sedatives to standard emergency-room remedies, the pharmaceutical supply cabinet is increasingly bare of the drugs of choice, according to doctors, advocacy groups, and the FDA.

Industry consolidation, random and unpredictable manufacturing problems, and simple economics, they say, have conspired to narrow the pipeline that delivers needed drugs to the point where shortfalls of key medications are more frequent and prolonged.

As a result, physicians must use second- and third-tier treatments. In some instances, according to a survey of 1,800 doctors and pharmacists by the Institute for Safe Medical Practices, patients have died for want of the preferred drug therapy.

And, in an ironic twist, the shortage of sedating drugs used in executions forced a number of states this year to put the death penalty temporarily on hold.

"It is a serious and growing problem," said John Hansen-Flaschen, chief of the Pulmonary, Allergy & Critical Care Division at the University of Pennsylvania Hospital. "For 12 or 18 months now, we have had sustained, absolute shortages of some of the most common intravenous drugs used in patient medicine."

Those include intravenous Lasix, a diuretic commonly used to treat congestive heart failure, and Cisatracurium, a muscle relaxant used in surgery, he said.

Elsewhere, there are critical shortages of chemotherapy drugs and even morphine, according to the American Society of Clinical Oncology (ASCO).

The American Society of Anesthesiologists (ASA) reports that its practitioners have been severely hampered by shortages of a variety of drugs used to sedate and immobilize patients undergoing surgery, including propofol, which is also used in executions.

"It has gotten to the point where anesthesiologists are thinking about it as they drive to work: Do I have a shortage of any these drugs? . . . How will I work around it?" said Mark Warner, a physician and president of the ASA.

Almost all the shortages are generic drugs, Hansen-Flaschen said, an apparent reflection of the fact that there are fewer manufacturers of such medications, which generate less profit than do brand-name drugs. With few producers, any breakdown in manufacturing or shortage of raw materials can trigger widespread shortages.