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National drug shortage affects Southern Wisconsin hospitals

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GINA R. HEINE
November 20, 2011
— A national drug shortage is forcing local doctors to reschedule surgeries.

Area pharmacists said multiple drugs are in short supply. Although lives have not been threatened, elective surgeries have been rescheduled at Mercy Hospital and Trauma Center to ensure an adequate amount of needed drugs is available for emergencies, said Don Janczak, director of pharmacy at Mercy.


More than 200 drugs are in short supply, Janczak said, and orders to drug wholesalers sometimes go unfilled or are filled only partially.


Drug shortages have tripled annually from 61 in 2005 to 178 last year, according to the U.S. Food and Drug Administration. Of the 127 studied shortages in 2010-11, 80 percent involved drugs given to patients through injection, including oncology drugs, antibiotics and electrolyte/nutrition drugs, according to the FDA.


The shortage hasn’t been much of a problem in retail pharmacies, said Joseph Riebe, pharmacist at Kealey Pharmacy in Janesville. An exception is Adderall, a drug commonly used to treat attention deficit hyperactivity disorder. Riebe said it’s virtually unavailable from any area pharmacy.


Pharmacists work with physicians to switch to appropriate alternatives, Riebe said. He’s been switching a lot of people from Adderall to Ritalin and hasn’t had “any real problems with coming up with an alternative for someone.”


Rescheduled surgeries at Mercy have included those requiring an anticoagulant. There’s not a shortage of anticoagulants, but the drugs used to reverse anticoagulation have been in short supply, Janczak said.


“The last three weeks or so, we’ve been struggling to maintain an adequate supply,” he said. “We’re fully stocked, now, so we’re OK. We had to make sure we had enough for trauma cases.”


Beloit Hospital hasn’t had to reschedule any surgeries, but they’ve come pretty close, said Patricia Brock, director of pharmacy for Beloit Health System.


“It’s impacted things like emergency syringes, pain killers, anesthetics and things used in surgeries,” she said. “It’s very difficult.”


Last week, Dean Clinic pharmacist Jeff Elser faced a new shortage for nystatin, used to treat yeast infections, and tetracycline, an antibacterial drug.


“These drugs are older than I am,” he said. “Just all of a sudden they have disappeared from the market.”


The two manufacturers of tetracycline only said it was temporarily unavailable with no estimated date of when it would be available. For nystatin, one company attributed the unavailability to raw materials, two companies discontinued making it and a couple other companies did not provide a reason, he said.


In the past, if a pharmacist was short on a drug, another hospital could lend a supply to be replaced later, Janczak said.


“Now, if I were to call another hospital and ask for a supply, it would be very unusual for them to give up their supply. They’re in the same situation as we are,” he said.


He encouraged patients to talk to their congressional representatives to bring attention to the issue.


All pharmacists interviewed said taking care of the patient is the main goal.


If a retail drug is unavailable, physicians work with pharmacists to find alternatives.


Patients in the hospital shouldn’t worry, Brock said, “because there’s people behind-the-scenes working to make sure they can get their drugs.”


WHY THE SHORTAGE?

Local pharmacists said fixing the national drug shortage isn’t easy because the causes are varied.


They said reasons include:


Manufacturing problems: Raw material shortages can make it difficult for manufacturers to bring drugs to market, said Don Janczak, director of pharmacy at Mercy Hospital and Trauma Center.


Business decisions: Two companies might merge and discontinue a drug both were producing, or manufacturers might make a business decision to discontinue a product. This is happening with many generic drugs that have been on the market for years because it might not be profitable to continue making the generic drug, Janczak said.


Regulatory standards: U.S. Food and Drug Administration inspections might force manufacturers to temporarily shut down production, and other companies can’t keep up.


President Barack Obama stepped in Oct. 31, ordering the FDA to help prevent and reduce drug shortages, protect consumers and prevent price gouging.


Pending legislation would require manufacturers to notify health care providers and wholesalers of impending shortages so people can prepare, said Jeff Elser, pharmacist at Dean Clinic.


A “gray market” for prescription drugs also has developed. Area pharmacists say they don’t buy from such suppliers, who price gouge, because they don’t know where the drugs are from.



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