Opioid Shortage Impact on Hospitals, Pharmacists

April 9, 2018

The shortage of injectable opioids is reaching critical levels in hospitals nationwide and leaving health system pharmacists scrambling to find alternative treatment options for patients who are undergoing surgery, battling cancer or recovering from traumatic injuries.

Supplies of hydromorphone, fentanyl, and morphine are dwindling, largely because Pfizer is renovating its main manufacturing plant in Kansas where prefilled opioid syringes are made. Syringe production will remain offline until the project is complete, which could extend into early 2019. Furter, other manufacturers of injectables don’t have the capacity or enough raw materials to fill the void.

Reports suggest the Drug Enforcement Agency (DEA) won’t up the supply of raw materials due to mandated annual caps that were implemented to help curb the current opioid epidemic.

“Manufacturers are ready to step in and increase production, but they are unable to do so without approval from the DEA,” said Mike Alkire, CEO of Premier, Inc., a national health care management firm that oversees nearly 4,000 hospitals. Premier said 96% of its health systems are experiencing moderate to severe shortages of injectable opioids.

“We understand and support the DEA’s goal to be judicious about the production of narcotics, but we believe we are in the midst of a public health crisis,” added Mr. Alkire, who said a temporary reallocation of supply quotas would allow other manufacturers to step into the void, potentially addressing a multi-year shortage in a matter of months.

Scott Knoer, PharmD, chief of pharmacy at Cleveland Clinic, said supplies of opioids began to dwindle last summer. Back then, the issue was largely manageable. It’s becoming less so now. “Some of the supplies are down to a week-by-week basis,” he said. “Hydromorphone levels are at the most critical level.”

Cleveland Clinic is a large health system made up of 10 hospitals, which lets Dr Knoer and his team leverage supplies and move products among the facilities to where they’re needed most. Still, the shortage is causing significant stress on his department and staff in terms of time, effort, and money.

Dr Knoer has hired a full-time drug shortage pharmacist whose sole job is to monitor drug supply levels, assess alternative therapies, and make adjustments as needed. Anytime a product is switched, his team must build new order sets in a hospital’s electronic health record, which he pointed out creates the potential for medication administration errors at the front lines of care.