Hospitals nationwide are facing chronic shortages of injectable versions of opioids, which are vital to patients on ventilators. Demand for injectable opioids more than doubled between January and April 2020 according to Vizient, a hospital purchasing organization. Premier Inc., another hospital purchasing group, reported that orders for the opioid fentanyl have tripled.
Since 2017, injectable opioids, including fentanyl, have been on the FDA’s list of drugs in short supply. This shortage is in part because injectable opioids are less profitable to produce. According to a 2019 report from the FDA, the price for injectable drugs can fall below the cost of production. By contrast, opioids like oxycodone, oxymorphone, and fentanyl in pill form have historically exceed $1 billion in sales.
Higher demand for opioid pills means less production of lower-margin injectable versions, according to Reuters. Data from the Drug Enforcement Administration shows that by 2006, the production of opioid pills was at least 9 times higher than that of injectable opioids.
To deal with the shortage, pharmacists, anesthesiologists, and other doctors have had to substitute their first choice painkillers with less effective drugs, like ketamine, which can have serious side effects, or to inject crushed opioid tablets directly into feeding tubes.