Trenton, N.J. – There is another opioid crisis happening in the U.S., and it has nothing to do with the overdose epidemic: Hospitals are frequently running out of widely used injected painkillers.

Manufacturing shortages are forcing many doctors and pharmacists to sometimes ration injected opioids, reserving them for the patients suffering most. Other patients get slower-acting or less effective pain pills, alternatives with more side effects or even sedation.

Medical groups are urging regulators to help, saying some people having surgery, fighting cancer or suffering with severe burns are getting inadequate pain control. They also say shortages frequently cause medication switches that could lead to deadly mistakes.

Earlier this month, the American Medical Association declared drug shortages a public health crisis, saying it will urge federal agencies to examine the problem as a national security threat and perhaps designate medicine factories as critical infrastructure.

Injected opioid shortages have happened before, in 2001 and 2010, but they weren’t as acute and long-lived, experts say. This one started almost a year ago and is expected to last into next year.

“It’s definitely the most severe I’ve seen in tracking drug shortages for 17 years,” says Erin Fox, a University of Utah Hospitals pharmacist. She tracks national medicine shortages and recalls two patients dying due to medication errors during the 2010 shortage.

Such shortages steal time from patient care, increase hospitals’ costs and affect just about every department, including operating rooms, emergency departments and cancer clinics. Doctors occasionally find opioids missing from emergency carts and surgery supply trays, “borrowed” by colleagues needing them for other patients.

The shortages started hitting hospitals last summer, after the Food and Drug Administration found sterility and other serious problems at a Pfizer factory in Kansas. The company, which makes 60 percent of the country’s injected opioids, had to slash production to fix the problems.

By January, shortages were so bad hospitals started creating teams to manage their supplies, said Michael Ganio, director of pharmacy practice at the 45,000-member American Society of Health-System Pharmacists.

The group’s April survey of 343 hospital pharmacists found 98 percent had dealt with moderate or severe shortages of the key opioids for treating serious pain: morphine, fentanyl and hydromorphone, better known as Dilaudid. Many hospitals were completely out of at least one.

With the opioid shortages lingering, hospitals and medical groups have set guidelines for stretching supply.

Some worry such workarounds invite mistakes.

Michael Cohen, president of the Institute for Safe Medication Practices, an independent group that compiles voluntary error reports, says mix-ups also occur when nurses or pharmacists substitute unfamiliar painkillers or ones with different concentrations than normal.


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