Drug shortages felt at hospitals and clinics near and far

EVERETT — A pharmacist for 35 years, there was a time Eric Werttemberger didn’t have to worry about the shortages.

These days a dearth of certain drugs is the norm — not just at Providence Regional Medical Center Everett where he is the pharmacy director, but at hospitals and clinics across the country.

“It’s every day there is a new drug that you can’t get access to,” Werttemberger said. “It runs the gamut.”

Shortages require health care providers to become increasingly flexible in a fluid market.

It’s a pressing issue at the national and local levels. Drug shortages present significant risks for patients and threaten the stability of the health care system, according to a June statement by the American College of Emergency Physicians and the American Society of Anesthesiologists.

The head of the Federal Drug Administration on July 12 announced the formation of a Drug Shortages Task Force.

“When shortages occur, practitioners are forced to ration supplies or substitute alternate drugs that in some cases compromise patient care,” FDA Commissioner Scott Gottlieb said in a statement at the time.

Eight days later, Congressman Rick Larsen paid a visit to Providence to learn more about challenges faced locally. He heard concerns from front-line medical professionals.

“With drug shortages, this is something that needs to be addressed at the federal level and I think he took that home,” said Dr. Ryan Keay, medical director of Providence’s emergency department. The hope, she said, is federal officials can get to the root cause.

Many drugs in short supply have been low-profit margin generic medicines. Often, they are sterile injectable drugs, which can be challenging to make on a mass scale, according to the FDA. There has been foreign competition with cheaper labor, cost-cutting business consolidations and moves to offshore production within the pharmaceutical industry. At the same time, the FDA reports “an under-investment in manufacturing. With few manufacturers operating at tremendous scale, if even one of the suppliers faces production problems, shortages can occur.”

All of those issues are compounded by health and safety regulations and close monitoring of products.

That is why a hurricane in Puerto Rico can affect a hospital or clinic in Everett. Puerto Rico has been a key supplier of the IV saline bags, and Hurricane Maria made for challenging times.

“Right after Puerto Rico, we were substituting a different solution when it was appropriate,” Keay said. “We were very much watching our supplies.”

There also has been a shortage of local anesthetics to manage pain in parts of the U.S. For instance, the fear in some parts of the country was a shortage could put expectant moms under general anesthesia during a Cesarean section and cause them to miss the first moments of their babies’ lives.

Pharmacists routinely scour reports of potential shortages and consult within the industry to compare notes on supply and on what might be the best substitutes when certain drugs aren’t available.

“It has gotten much worse in the last decade,” Werttemberger said. “It was almost unheard of maybe 15 years ago.”

It is not a cause for alarm but it is important for the public to know the drug supply marketplace is in flux, he said.

“It’s somewhat fragile when it becomes a commodity low-price item,” Werttemberger said.

“I think the public will become more aware,” he said. “At this point we are fortunate to have alternates. At some point, it will be something absolutely vital and then they will become aware of it.”

As for now, the shortages will continue largely unnoticed by those not in the medical industry.

“Any more you just roll with the flow and you figure out what you have to do,” Werttemberger said. “Is there an alternate? You just sort of go into your tactics for resolving it.”

Eric Stevick: 425-339-3446; stevick@heraldnet.com.