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National Drug Shortage Crisis Impacts ENC

  For more than a decade, the United States has been dealing with a major drug shortage crisis, costing lives and money.

Though the worst of it may be over, hospitals in eastern North Carolina are still dealing with the shortage while learning how to work around it.

Chris Thomas has this.

Over the past 15 years or so, pharmaceuticals across a wide spectrum have been in short supply due to a variety of reasons including cost of manufacturing and a lack of raw material. According to a July report from the Government Accountability Office, there were 427 drugs were on the shortage list in 2015.

The shortage impacts many hospitals in eastern North Carolina forcing them to get creative.

“When (a drug) is out, sometimes we have to switch to a different medication in that class or we work with the providers to make sure that we are still providing the best care that we can.”

Genelle Butz is the director of pharmacy at CarolinaEast Medical Center in New Bern.

“With the shortages we have to look for a different drug in the same class of medications which means that we’ll be spending more money.”

The Drug Shortage Crisis, as it was called by the House Oversight Committee in 2012, has cost hospitals hundreds of millions of dollars over the years. Butz says shortages have leveled off since then and now they’re adjusting to a new reality.

Credit Government Accountability Office
Government Accountability Office
Data from the Government Accountability Office on the Drug Shortage Crisis

“It got really bad about 5 years ago and it’s been just our day-to-day practice now that we are managing some shortage or another.”

Drug shortages aren’t uncommon on their own. Physicians can work around that by using similar drugs or combining different substances.

But Paul Gibbs, pharmacist at the Leo W. Jenkins Cancer Center in Greenville, says the crisis goes beyond scarcity.

“What we have found in some cases is we’re not even able to get the product so when you’re not able to get the product then that comes to more of a serious issue…if there is a need for that product specifically or you don’t have an alternative agent then you have those kind of dilemmas on what to do and how to proceed with your treatment.”  

A raw material shortage is where the problem begins. Raw materials include propiophenone.  The Food and Drug Administration states that shortage accounts for 27 percent of the reason why the drug shortage crisis persists.

The crisis primarily impacts people who rely on injectable drugs, like Epipens.

“So if the raw material isn’t readily available then you can’t purchase it. When we have a shortage, people generally try to purchase more, just to make sure they have enough on-hand for their patients. So it’s a matter of making sure we’re not creating a panic in the market and balancing that with ensuring you have enough on hand to get through the shortage”

One category stands out especially to Butz in 2016.  

“This year it looks like antibiotics are going to be a problem for us so we may be choosing an antibiotic that maybe more aggressive than we need so then we run into problems with antibiotic resistance. So trying to keep that contained is always a hurdle.”

Drugs that fight cancer are also seen frequently on the shortage list. In 2013 a national survey of 243 patients by St. Jude Children’s Medical Center found 98 percent of them dealt with drug shortages within the past year.

But that isn’t the case for cancer patients across the board, especially for the most common kinds of cancer, Paul Gibbs explains.   

“And in those cancers that are the most prevalent, what we have found is the majority of the treatment for those cancers, the drug shortages haven’t been directly on those types of regiments.”   

He said medication for Leukemia patients has been scarce. He couldn’t pinpoint a particular number of patients affected by the drug shortage locally, though Leukemia, Lymphoma, and Myeloma patients accounted for 10.2 percent of new cancer diagnoses this year.

Since there are fewer people with Leukemia than Breast or Prostate Cancer, there’s less incentive to make drugs that fight it.

Getting what you need in a market plagued by scarcity, Butz said, can be a struggle.

“Whether the wholesaler just received a shipment, you can try to purchase some while they still have it on hand because everybody’s looking for it. It’s…almost like ‘Black Friday’ for drugs.”     

A 2009 report by the American Society of Health-System Professionals stated rural hospitals are especially vulnerable to drug shortages since they’re often further away from distribution centers.

Genelle Butz at CarolinaEast New Bern says she doesn’t believe they’re at a disadvantage because of their location. She believes hospital organization and vigilance is a more important factor.

“Constant surveillance of what’s available within our wholesaler and then trying to obtain it as things come in and just depending on whether you have the stuff available to keep a close eye on whether the wholesaler just received a shipment and purchase some while they still have some while they still have it on-hand.”

Things are slowly improving.

After the crisis hit its peak in 2011, there’s been a relatively steady drop off in new drugs added to the shortage list. But 291 drugs that were previously on the list were still in short supply at the end of 2015.

Little seems to indicate a significantly smaller shortage list in 2017.