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In the United States, about 1 in 20 people has to go to the emergency room (ER) in any given year, but there's a crisis brewing in American emergency care that can't be fixed with a suture, a bandage, or good medical advice.
According to the journal Academic Emergency Medicine, incidents of drug shortages have increased more than 400 percent between 2001 and 2014. The drug shortage list in hospital emergency rooms includes:
- Nalaxone, the only injectable drug for opiate overdoses, in high demand not just in ERs but for use by emergency medical technicians and police.
- Antivenin polyvalent injections for treating snake bites.
- Hydrocodone (Vicodin) for treating pain.
- Acyclovir for treating acute viral infections.
- Broad-spectrum antibiotics, used to treat serious bacterial infections during the two days it takes to run cultures in the lab to identify the specific bacteria causing the infection and the best treatment for those bacteria.
- "Gold-standard" antibiotics including aztreonam, used to treat serious infections in patients who are allergic to penicillin, and trimethoprim/sulfamethoxazole, used to treat pneumocystis pneumonia in AIDS patients.
All of these drugs and over 100 more are essential to treatment in some situations, and not having them is a threat not just to recovery but to survival itself.
Dr. Jesse Pines, director of the office for clinical practice innovation at George Washington University School of Medicine & Health Sciences and lead author of a study of the causes of chronic drug shortages in ER's in the United States says that there are a variety of reasons particular medications may be in short supply.
- 2.1 percent of the time the reason is a "business decision" by the pharmaceutical companies to focus on making drugs that are more profitable.
- 4.4 percent of the time there is a shortage of raw materials.
- 14.9 percent of the time demand simply exceeds the ability of the company to supply the drug.
- 25.6 percent of the time there are manufacturing delays. But
- 46 percent of the time there is no reason given for not supplying a medication.
In the United States, the FDA has limited power to prevent drug shortages. It can identify medically necessary drugs, medications that play a vital role in treating disease for which there are no substitutes. It cannot force drug companies to make a drug or to make more of a drug even if it is medically necessary, and it cannot tell drug companies the price to charge for a drug. Even when drug companies reduce the price of a drug, wholesalers may not pass the price reduction on to hospitals, and hospitals cannot be told how much to charge patients. There are, however, medical guidelines concerning who gets a drug that is in short supply.
The FDA realizes that increasing supervision of the production of medically necessary drugs could achieve an unwanted result. Drug companies could decide that the cost of complying with FDA regulations would make producing a drug unprofitable and simply refuse to make it. (In other countries, such as Germany, this decision is not an option.) However, drug companies in cooperation with federal authorities and hospitals often manage to prevent drug shortages from becoming critical.