Medication Shortages

When we think of limitations that prevent patients from getting medications, we think of insurance reasons, access to physicians and pharmacies, cost, language barriers, or education limitations. We don't normally worry that the drugs are not available because there's a shortage. But as an anesthesia resident, I have become painfully aware of medications with limited supply.

Today, I was reminded that there's been a six-month dearth of calcium chloride. This boggles my mind. Calcium isn't some fancy targeted immunotherapy. And even more, calcium chloride is a code medication used in emergencies. And it's not just calcium; we have shortages in fentanyl, morphine, atropine, labetalol, and a few other drugs.

How can this be so? How can we have a shortage of drugs we use daily or medications necessary in emergencies? Is medicine this vulnerable to the fickleness of supply and demand? Are there so few suppliers that if one gets into problems, no one can get the medication? And what are the issues for the manufacturers? Medications don't just grow on trees (well aspirin, taxol, and a few others do). But there are a lot of factors doctors don't know. Who makes the drugs? What regulations make it difficult to enter the market? What incentives are there to keep hospitals supplied? What backup mechanisms are in place if a company goes out of business?

Image of Bayer heroin bottle is in the public domain, shown under Fair Use.