Unacceptable shortages of emergency drugs persist. ACSH advisor tries to explain.

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Screen Shot 2014-03-27 at 2.35.26 PMACSH advisor, Dr. Robert Glatter, an emergency room attending physician at New York s Lenox Hill Hospital, has seen more than enough when it comes to the recent plague of shortages of commonly used, mainly injectable generic drugs in his ER. Now, the recently announced shortage of nitroglycerine given to heart attack patients in the ER may have been the straw that broke the camel s back.

Here are some of Dr. Glatter s comments from his recent letter to ACSH:

Prior to 2006, emergency medicine physicians have had access to essentially any drug available to treat the wide range of conditions that present to the emergency department. Unfortunately, in 2014 eight years after this crisis started we have a significantly reduced supply of commonly used, and life saving medications.

For example, patients with migraine headaches may be treated with the common migraine medications prochlorperazine and metoclopramide, but these two drugs continue to be in short supply at times. In addition, badly needed sedatives, such as (lorazepam (Ativan) or diazepam (Valium) are used to stop seizures, but these have been in short supply for years.. The effect of this shortage can lead to alternative medication choices which can lead to substandard care placing patients at risk for adverse outcomes. The inescapable conclusion is that when financial incentives influence drug availability, patients suffer in the end.

Generic drugs are off patent and expensive to produce but inexpensive to purchase make up virtually all of the medications on the shortage list. Even intravenous fluids such as saline, another staple in every emergency department and operating room, has been in short supply in the past 6-8 months, supposedly driven by the high usage rates during flu season according to the manufacturers. But, in reality, this has more to do with fewer saline manufacturers as well as cutbacks in manufacturing.

With Medicare generally willing to pay the selling price plus 6%, and benefit managers negotiating large volume discounts, further decreasing the selling price, there is essentially no financial incentive to produce many generic, injectable drugs.

The core issue is that, until recently, the federal government has not been responsible in its supervision of the pharmaceutical industry to ensure that drugs for emergency conditions continue to be produced in normal quantities.

You can read Dr. Glatter s important letter in its entirety here.

(Note: ACSH s Dr. Josh Bloom has written about this vital issue in the past. You can read his New York Post op-ed, Running out of Common Drugs here.)