MORGANTOWN – Supply-chain problems have been a daily topic of discussion during the pandemic.
But a reader’s difficulties in getting a refill on a simple and inexpensive medication led The Dominion Post to learn that drug shortages are not uncommon, or new.
The medication in question is hypertonic saline solution for use in a nebulizer. Talks with three major pharmacy chains revealed that it’s been on back order for months and they didn’t know when they’d get new stock.
The shortage extends beyond various strength nebulizer solutions to include all types of saline products, such as saline IV bags used in hospitals.
Dr. Todd Karpinski, WVU Medicine chief pharmacy officer, told The Dominion Post there are a variety of reasons. Several manufacturers are experiencing delays. Baxter, the nation’s largest supplier of saline bags. Is experiencing delays at its plants and in sourcing products from third parties, for example.
Becker’s Healthcare and Bloomberg report that supply-chain problems, ongoing worker shortages and increased demand during the COVID omicron variant surge are contributing to the saline shortage.
Bloomberg said Pfizer, one of the main suppliers of small saline vials, needed to dedicate its containers to making COVID vaccine. As omicron illness and quarantines kept factory workers at home, the problems snowballed and small bags of saline, which nurses often use when they lack vials, ran low.
The problem became so bad that National Jewish Health sent out this warning: “Currently there is a nationwide shortage of sodium chloride. This is impacting patients with bronchiectasis who perform twice daily airway clearance with hypertonic saline, which is also known as sodium chloride. … It is STRONGLY discouraged to create your own solution as it could cause serious harm to your lungs.”
Karpinski said that ASHP – the American Society of Health-system Pharmacists – works with the University of Utah to track shortages and there can be 800 active drug shortages at any given time.
“It’s often unknown why there’s shortages,” he said.
The problem stems back to the early 2000s, he said, and various factors play a role. One is insufficient API – active pharmaceutical or active product ingredient.
Global Phrama Tek explains that the vast majority of API is produced in India and Asia. Karpinski said those plants are subject to FDA inspection and can get shut down, causing shortages.
Elsewhere, Hurricane Maria hit Puerto Rico in 2017, closing Baxter’s plant there and causing a shortage of all fluids.
Another reason, he said, is generic products. Their lower costs benefit the consumer, but as more players enter the market can get diluted and profits fall off. Some makers drop out and the survivors can raise prices. And fewer manufacturers can lead to shortages.
“It’s not an issue that’s new to us in pharmacy. Its an issue we contend with every day,” he said. Ruby Memorial has a staff member whose sole job is to work on drug shortages.
He recalls a time when certain chemotherapy drugs were shorted and they had to delay treatment for some. “Which is never good when you’re treating cancer, particularly pediatrics.” It delays therapy and forces the hospital to spend more on drugs than it needs to.
Bloomberg reported that pharmacists and saline manufacturers expect shortages of saline vials and bags to ease when the omicron surge eases. Baxter is trying to increase production and expedite shipping. Another manufacturer, Fresenius SE, is also running at full capacity.
Beyond drugs, medical supplies can also face shortages. Another reader told of difficulties obtaining syringes for home injections and some local pharmacies have dealt with on-and-off shortages and regular back orders.
Karpinski said, “Syringes and vials have been really shorted.”
COVID has played a role in that. Millions of syringes are being used for COVID vaccines, he said. IV bags are also in short supply. Shipments from China are delayed. “It’s a constant struggle.”
Asked what advice he would offer about coping with shortages, Karpinski said a hospital should determine who has the most critical need. Ask if there is a short-term alternative. Ration as much as possible. Avoid hoarding, which some hospitals have done. “It really only makes the problem worse for the masses.”
On the topic of solutions to drug shortages, Karpinski cited the example of Civica, a company created to combat shortages through domestic production.
Civica cites studies that show prices for drugs under shortage increased more than twice as quickly as they would in the absence of a shortage, adding $230 million a year to U.S. drug costs; and combined, drug shortages reportedly contribute to over a $500 million in increased costs.
Karpinski said, “We’re really wanting to get back control of active product ingredients and product preparation because we can’t rely on the Chinese and the Indian governments to supply us. They could cut us off at any time.”
Tweet David Beard @dbeardtdp Email dbeard@dominionpost.com
