As pharmacies and hospitals struggle with the nationwide dearth of Adderall generics, drug shortage expert Erin Fox, PharmD, spoke with Becker's on Sept. 28 about frustrations with ongoing shortages, how the issue bleeds into staffing shortages and the "silver lining" to running low on older treatments.
Here's what Dr. Fox, a pharmacy professor at the Salt Lake City-based University of Utah who helps run the American Society of Health-System Pharmacists's drug shortage website, listed as the top five drug shortages:
1. Local anesthetics, such as lidocaine, bupivacaine and combined products with epinephrine: "These have been short for years, but they have worsened recently, especially the combination products. What makes it hard is it's not that you can't get any, it's just that you maybe can't get the right size or the right strength. It's frustrating for clinics and providers to want 1 percent, but you can only have 2 percent, or vice versa. People are making do, but when you train people to use certain products, it's a risk for a potential medication error."
2. Blood pressure drug dobutamine: "That one has been problematic, [but] it's getting a little bit better." Dobutamine, which is in short supply because of manufacturing delays for Baxter and Pfizer, does not have a lot of other alternatives for heart failure patients, Ochsner Health's vice president of pharmacy services recently told Becker's. The American College of Cardiology issued a guidance in early August for clinicians about the shortage.
3. Oxytocin, a treatment used in childbirth: "It's not in crisis mode, but people are worried about it." Some oxytocin injection products are expected to return to normal supply levels in early November, according to the ASHP.
4. Albumin 5%, a drug for low blood volume: The product, which is on back order at four drugmakers as of Sept. 23, "is getting a little tricky."
5. Heparin flushes: "It sounds silly; it's not a critical, lifesaving product by any means, but it certainly has created a lot of work for our organization this week." Heparin, which is used to flush or clean out IV catheters, is a "basic product that we need to keep things running," Dr. Fox said, "and when you're short on those, it creates a lot of extra work for our staff."
The difference between 10 percent and 20 percent of local anesthetics will not make a big difference for patient care, Dr. Fox said, but the pharmaceutical workers have to tack on more work before physicians can do surgeries needing anesthetics, stitches and biopsies. The extra workload is not only frustrating, but it can spill over into other ongoing issues such as healthcare hiring and retention rates.
However, there is a "slight bright spot" to some drug shortages, Dr. Fox said.
With older drugs that are not as regularly tested on whether they still work, one question pops up: "Is there truly going to be a clinical benefit for the patient? Sometimes that's unclear," she said. "Every once in a while, we'll have a shortage that can really help us take a step back, look at the literature and understand which patients truly benefit from a product and which patients don't. That's the silver lining. These drugs are very cheap and it's not that patients are having bad outcomes if they receive the drugs, so normally it wouldn't make sense to take that kind of deep dive. But with shortages, we sometimes get that chance."