US Emergency Departments Face Serious Drug Shortages

Two emergency physicians classified drug shortages based on whether they were within the scope of EM practice, whether they are used for lifesaving interventions or high-acuity conditions, and whether a substitute for the drug exists for its routine use in EM.

The results showed that of the 1,798 drug shortages recorded over the 13-year period, 33.9% were classified as within the scope of EM practice. Of those, 52.6% were for drugs used as lifesaving interventions or for high-acuity conditions, and of those, 100% were for drugs with no available substitute. The researchers also found that although the prevalence of EM drug shortages fell from 2002 to 2007, the number of EM drug shortages sharply increased by 435% from January 2008 to March 2014.

During the same period, shortages in drugs used as a direct lifesaving intervention or for high-acuity conditions increased by 393%, and shortages for drugs with no available substitute grew by 125% (from four to nine). Almost half of all EM drug shortages were caused by unknown reasons, with infectious disease drug shortages being the most common among EM drugs. The study was published on December 31, 2015, in Academic Emergency Medicine.

“Many of those medications are for life-threatening conditions, and for some drugs no substitute is available,” said senior author Jesse Pines MD, MBA, MSCE, of the University of Utah. “This means that in some cases, emergency department physicians may not have the medications they need to help people who are in serious need of them.”

According to the US Food and Drug Administration (FDA), a wide range of medications used both in EM and in pre-hospital settings, such as antidotes, heparin, and nitroglycerin have been affected by national drug shortages. Quality control problems, such as bacterial contamination or the presence of glass or metal particles in drug vials that result in supply disruptions are the most frequently cited causes for drug shortages. But another, non-measurable factor that affects drug shortages is the underlying economics of the pharmaceutical market.

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