Article 4: Critical Medications in Short Supply

Any medication may be susceptible to a shortage; however, medications used during intensive and emergency care are particularly vulnerable during this time.

​Several medications have been on shortage for years, and the current COVID crisis has only worsened the problem.  Specifically, in the past few months, manufacturers and health systems have been experiencing a surge in demand for several critical medications – this is met with a decrease in supply, ultimately leading to drug shortages.  Increase in demand necessitates the growth of access strategies. Other medications have recently become limited or unavailable due to the surge of demand and the lack of adequate supply to fulfill that demand.  We have seen manufacturers and organizations come out and warn the public that medications (e.g., acetaminophen) may become temporarily unavailable due to a surge in demand.(1)
 
Medications used during intensive and emergency care are of particular concern during this time. On a basic level, we need access to specific medications (e.g., sedatives and paralytics) in order to use the ventilators.  Examples of therapeutic classes in high demand include sedatives, analgesics (e.g., opioids and acetaminophen), paralytics, muscle relaxers, bronchodilators, vasopressors, total parenteral nutrition, electrolytes and fluids, cardiac support, and infectious disease agents (e.g., antivirals and antibacterial agents). Many of these agents are confirmed shortages on both the ASHP and FDA databases.(2,3) The most common reasons provided by manufacturers for these shortages include increased demand, manufacturing delays, or no reason given at all.
 
Vizient, Inc recently released a report that highlights the percent increase demand of specific medications for March 2020 compared with the fill rates.(4) According to the report, there was a 91% increase in demand for sedatives and anesthetic (e.g., ketamine, dexmedetomidine, etomidate, lorazepam, propofol, and midazolam), with a fill rate dropping to 48%.(4)  As for analgesics (e.g., fentanyl, morphine, and hydromorphone), there was a 79% increase in demand, yet the fill rate was 71%.(4) Neuromuscular blockers (e.g., rocuronium, vecuronium, cisatracurium, and succinylcholine) have seen a 105% increase in demand, however, fill rates were as low as 37%.(4)
 
To help address shortages of opioids and controlled substances, the U.S. Drug Enforcement Administration (DEA) announced on April 7th, 2020 it will allow for increased production limits of medications such as fentanyl and morphine, as well as increased imports of medications such as lorazepam, diazepam, midazolam, phenobarbital, and ketamine.(5) The FDA has issued a list of products that may be used beyond the labeled expiration dates to allow extended use given the current supply issues.(6)
 
At this point, it is safe to assume that any drug could be susceptible to a shortage now or in the future.

Previous Article # 3
Drug Shortages – Part II of II

Article # 5:  
​Understanding the Global Medication Supply Chain




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Disclaimer
Information is constantly evolving in the healthcare space. Responsible effort was made to provide accurate information from reliable sources at the time of publication. Information provided in the articles and website is done so in good faith; however, no liabilities for the information (such as errors or omission) exist. The reader should make their own assessment and determination of how they will use the information provided. The author and publisher provide no guarantees of any specific outcome or consequence as a result of utilizing recommendations or information offered in this article. Readers are advised to continuously check the latest updates, practices and guidelines.



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1. Fierce Pharma. Johnson & Johnson post ‘temporary’ Tylenol shortage amid heightened demand. https://www.fiercepharma.com/manufacturing/johnson-johnson-reports-temporary-tylenol-shortage-amid-heightened-demand
2. American Society of Health-System Pharmacists (ASHP). Drug Shortage List. https://www.ashp.org/Drug-Shortages/Current-Shortages/Drug-Shortages-List?page=CurrentShortages
3. Food and Drug Administration. Drug Shortages. https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages
4. Vizient, Inc. COVID-19 impact on drugs essential for ventilator use Report. Updated 4/7/20. https://newsroom.vizientinc.com/sites/vha.newshq.businesswire.com/files/doc_library/file/COVID-19_impact_on_essential_meds_for_ventilator_use_-_FINAL.pdf
5. Drug Enforcement Administration. DEA takes additional steps to allow increased production of controlled substances used in COVID-19 care. https://www.dea.gov/press-releases/2020/04/07/dea-takes-additional-steps-allow-increased-production-controlled
6. Food and Drug Administration. Search List of Extended Use Dates to Assist with Drug Shortages. https://www.fda.gov/drugs/drug-shortages/search-list-extended-use-dates-assist-drug-shortages