Shortages Are Forcing Physicians and Pharmacists to Ration Opioids

A nationwide shortage of opioids has now become a public health crisis, according to the American Medical Association. The shortage is forcing hospitals to ration the use of opioids and, in some cases, encouraging doctors to prescribe slower-acting or less-effective pain medications, even for patients who likely require intravenous opioids to manage their pain.

The shortages affect supplies of morphine, fentanyl, and hydromorphone, as well as local anesthetics like lidocaine and bupivacaine. Health-care providers are finding that, in addition to the use of inadequate pain management, rationing these drugs has led to confusion and mistakes, as doctors, nurses, and pharmacists mix up drugs or use incorrect dosages.

The Associated Press reported on instances when doctors are forced to initially prescribe pain pills for patients, only allowing the use of intravenous opioids if the first treatment proves insufficient. Others have resorted to using fentanyl, which requires more frequent doses and more staff time that could be spent with other patients.

The opioid shortage can be largely attributed to problems at a Pfizer factory in Kansas, which slowed its production of opioids to address U.S. Food and Drug Administration (FDA) quality concerns. Pfizer, which manufacturers 60 percent of the country’s injected opioids, does not expect to reach full manufacturing capacity until 2019, and the smaller firms making up the remainder of the market are struggling to fill the gap.

The FDA is attempting to address this problem by expediting approvals to these smaller companies, which are now shifting their production priorities to injected opioid manufacturing. The agency also is allowing Pfizer to distribute prefilled opioid syringes that had previously been held back for fear of possible contamination.

Source: Associated Press, June 27, 2018.