A national drug shortage crisis is potentially affecting the care received every day for thousands of patients undergoing anesthesia. In an informal ASA member survey, more than 98 percent of respondents noted that they now regularly experience drug shortages at their institutions and more than 95 percent of respondents said the shortages impact the way they treat their patients.
Shortages of injectable opioids and local anesthetics are affecting many anesthesiology practices, public, private and academic throughout the country. Multiple causes have been cited including: pharmaceutical company consolidation, a vulnerable supply chain including production limits from the United States Drug Enforcement Agency, key supplies of these drugs being limited to a single manufacturer, lack of back-up production and reliance on a production facility in Puerto Rico that was damaged during Hurricane Maria.
Historically, drug shortages occur cyclically throughout the years, but the current crisis appears to be more significant, making it a top priority of the Society. So much so, ASA President James D. Grant M.D., M.B.A., FASA, addressed the issue by asking ASA members to complete a short, informal survey to garner information about specific drugs in short supply, or that are unavailable, as well as how the shortages are affecting patient care. Dr. Grant noted that the member information was critical to increase the understanding of the issue by regulatory organizations and policymakers.
"ASA spends countless hours working with Congress and leading drug shortage stakeholders as well as collaborating with federal agencies on solutions to combat this important problem," said Dr. Grant. "But we've been told by some policymakers that they could use more information and detail about how this is affecting our specialty and the way we care for our patients. The survey gives real life details to how these shortages are affecting our patients as well as the concerns our patients have about their recovery and postoperative pain."
Almost 2,500 members (close to 5 percent of ASA members) completed the informal, non-scientific survey. Ninety-eight percent of respondents said they are experiencing drug shortages on a consistent basis. More than 95 percent of respondents noted the shortages are affecting how they care for their patients. The top five drugs listed in short supply were pain relief medications like hydromorphone (dilaudid), fentanyl, and morphine, the local anesthetic drug bupivacaine, and the life-saving drug epinephrine.
One respondent noted, "I'm having to use much older drugs with more significant side effects that seriously impact efficiency, quality and patient satisfaction. Patient safety is also at risk since many health care professionals have little to no experience dealing with these older drugs."
Another survey respondent noted, "The local anesthetic shortage caused us to suspend our acute pain service for nearly four weeks, resulting in patients experiencing more pain, higher narcotic usage, and unnecessary admission."
"Oral treatments take far longer to work than IV treatment, so patients who have had major surgeries are suffering in pain due to lack of quick acting medications. I have had patients ask me about the drug shortages as they have been publicized in the news and they fear surgery due to the impending pain they'll have postoperatively," noted a survey respondent. "So imagine already fearing a surgical procedure that must be done as a life-saving measure, but also fearing the probability that your pain won't be controlled afterwards."
Although this survey was an internal member instrument and not scientifically validated, the findings and anecdotal reports are cause for concern. ASA is aggressively and continually working with key policymakers and stakeholders, including federal agencies and Congress to ensure they are aware of the impact on patient care and offering to partner with them to work toward both short and long-term solutions to this serious problem.