Drug Shortages in the ER

Drug shortages in healthcare have been increasing in the last few years and have frustrated many a physician in various specialties. A survey was just done by Premier Inc., which showed that nearly 90% of healthcare facilities surveyed experienced shortages that may have caused a patient safety issue or error in patient care. 

In the emergency department the recent shortages that have affected us most have been norepinephrine (Levophed), succinylcholine (Anectine) and metronidazole (Flagyl). The first two are critical care drugs that may be life saving and for which there are no comparable medications with the same pharmacologic profile. Metronidazole is a very common and older medication that is used frequently. The only real alternative is a newer, branded and expensive medication.

I had a recent patient with a trichomonas infection for which I prescribed metronidazole. She of course was uninsured but this prescription is not that costly. Unfortunately, due to the lack of supply at pharmacies in our area, she could not fill the medication. The only alternative was a branded medication that is well over $100, which she just could not fill. She did not return to the ED and I doubt she got treated for this infection, potentially passing it on to others.

The increased cost to the healthcare system by using more expensive alternatives or added expense of untreated infections and complications is significant. Premier’s analysis suggests an annual cost to U.S. hospitals of at least $200 million for purchase of more expensive alternative medications. I would venture the total cost when you include patient non-compliance due to affordability, poor outcomes and medical errors from substitutions to be much higher.

The report sheds light on the many reasons as to why the shortages have been increasing. Some are beyond the control of the pharmaceutical companies for sure. I do believe however, that the financial decisions made by these companies as to what medications are profitable and maintaining low inventories are remediable. These companies in my opinion should bear some of this increased cost. Only when there is some type of penalty or consequence, is this problem with drug shortages going to start improving. I have already written to my elected officials and I recommend all physicians affected do the same.