‘A tragedy happening in slow motion’: The acute shortage of drugs in the US and what’s causing it

The United States is facing a pandemic — a pandemic of drug shortages. A new report helmed by the Senate Homeland Security and Governmental Affairs Committee has revealed that the world’s richest country is struggling with shortages of inexpensive yet critical medication, forcing hospitals to make “horrible” choices. The report adds that these drug shortages not only pose threats to patients, with some facing “devastating consequences” but also is a risk to national security. Shortage of drugs According to the report — The Health and National Security Risks of Drug Shortages — shortages of critical medications continue to rise — including drugs used in hospital emergency rooms and to treat cancer, prescription medications, and even common over-the-counter treatments like children’s cold and flu medicine. The report states that new drug shortages in the US increased nearly 30 per cent between 2021 and 2022 and that at the end of last year, the country saw a record five-year high of 295 active drug shortages. It also found that while the average drug shortage lasts about one-and-a-half years, more than 15 critical drug products have been in shortage for over a decade. For instance, the US is struggling with a shortage of lidocaine injection — a local anaesthetic — for the past 11 years. Doxorubicin, which is used in chemotherapy, has been in short supply for the past 12-and-a-half years. [caption id=“attachment_12338932” align=“alignnone” width=“640”] The US has been grappling with a shortage of Tylenol, used to treat colds and flus. File image/AP[/caption] That’s not all. Americans are struggling to find other drugs such as liquid albuterol , which is used to treat patients with respiratory illnesses. There is also an ongoing shortage of Adderall — used to treat attention-deficit/hyperactivity disorder, or ADHD. The Food and Drug Administration (FDA) says the shortage stems back to October 2022, when there were some manufacture challenges, but now it’s due to increased demand. **Also read: Why does Idaho want to bring back firing squads for executing prisoners?** Propofol, a sterile injectable sedative that anaesthesiologists often given to patients before surgery, is currently in shortage and “has gone in and out of shortage” over the last 15 years, the report said. Morphine injection, amoxicillin oral tablets, which is an antibiotic, and even Sodium chloride (IV saline) is in shortage in the US. Deadly consequences The impact of such drugs being scarce in supply is having a disastrous impact on the American citizens and the healthcare system in the US. Dr Andrew Shuman, a cancer surgeon in Michigan, who spoke to senators at a hearing on the matter said that shortages in his field have come to “represent a tragedy that’s happening in slow motion.” Shuman, as per a New York Times report, said one cheap and established cancer drug called etoposide was recently in scarce supply. He said he had to weigh which patients, young and old, with lung, brain and testicular cancer should receive the limited number of doses. “As a doctor who has devoted my life to fighting cancer, it’s hard to express how horrible that is.” Dr Yoram Unguru, paediatric haematologist/oncologist, in the report stated, “Shortages are a dotted line that can be connected to deaths.” [caption id=“attachment_12338972” align=“alignnone” width=“640”] Several drugs related to cancer treatments are also facing a shortage. As Dr Yoram Unguru, paediatric haematologist/oncologist, in the report stated, “Shortages are a dotted line that can be connected to deaths.” Image used for representational purposes/Reuters[/caption] The report also stated that in many cases owing to the shortage of a drug, hospitals and medical staff were switching treatments. This poses problems of its own. For instance, shortages of injectable sedatives, like lorazepam, affected alcohol withdrawal protocols to the point where nurses had to provide oral tablets instead of injectables, which presented a number of difficulties, including patient compliance and a longer release time. Additionally, if drug are unavailable due to a shortage and there is no substitute, patients are forced to wait to receive treatment. However, in some cases such as cancer patients do not have the luxury of waiting and must go with a different regime that might not necessarily have a high positive clinical outcome. Reason for the shortages There is no one fixed reason why America is facing a shortage of drugs. As the report states, the underlying causes of drug shortages have generally not changed since 2019. These primarily include economic drivers, quality issues, over-reliance on foreign sources, increased demand, and logistical and regulatory challenges. US Pharmacopeia, a non-profit focused on a safe drug supply had an interesting take on the drug shortages, which was highlighted in the report. It found that there is a higher risk of shortages for drugs with a low price. Another problem is the dependence on overseas markets for generic drugs. Many ingredient makers are based in China or India. In fact, the number of Chinese-based makers of active pharmaceutical ingredients (API) more than doubled between 2010 and 2015. **Also read: How the campaign in the US to make insulin cheaper just scored a major victory** This means that if there are work stoppages or a problem in that region, the manufacturing will stop and, in turn, affect the US. Moreover, political instability of tensions between the countries, as is with China and the US, could affect the supply of drugs. Committee Chairman Gary Peters in his opening remarks at a hearing on the report’s findings, highlighted this point. “US’ over-reliance on foreign suppliers, especially those in China, remains an unacceptable national security risk.” But not all shortages are owing to an external issue as is the case with liquid albuterol. Akron, the supplier of albuterol has shut down its US operations, which include manufacturing facilities in Illinois, New Jersey and New York. This, in turn, has affected the supply of the drug. There’s also the problem of rising demand of drugs and over prescription. The COVID-19 pandemic saw millions of people falling sick and needing drugs to ameliorate breathing problems. Similarly, the flu and allergy season has led to more people falling sick, requiring antibiotics. The other issue is over-prescription. The Health Policy Institute in 2021 said that a whopping 66 per cent of all American adults are taking prescription drugs. In fact, Adderall remains one of the most commonly prescribed drugs in the US, with more than 41.4 million prescriptions issued in 2020 alone. It’s not yet clear what if any action the US Congress is taking in the matter, but as Erin Fox, an expert at the University of Utah who tracks drug shortages, said in a New York Times report, “The matter deserves attention. Unlike other products, people’s lives are at stake.” With inputs from agencies Read all the  Latest News ,  Trending News ,  Cricket News ,  Bollywood News , India News  and  Entertainment News  here. Follow us on  Facebook,  Twitter and  Instagram.