Hospitals fight drug scarcity, fear patients harmed

CANCER, ANESTHESIA AND NUTRITION

A clinical nutrition group, the American Society for Parenteral and Enteral Nutrition (ASPEN), found that 70 percent of its 800 members who responded to an online survey, said they had seen shortages of adult injectable multi-vitamins, used for basic nutrition for patients with intestinal issues. ASPEN members responding to the survey included doctors, nurses and pharmacists.

More than a quarter were not giving their patients multi-vitamins because of the shortages, placing them at risk of severe vitamin deficiencies that can lead to issues like anemia, due to a lack of folate, or scurvy, which happens when people do not get vitamin C.

In extreme cases, a deficiency of a type of B vitamin called thiamine can lead to cardiac arrest or death.

“This is an act of daily living for people now,” said Jay Mirtallo, president of the group. “How that can be acceptable, I don’t understand.”

When a drug is not available, doctors have to seek alternatives, which may not work as well or cost more money. Others have to ration limited supplies of a life-saving treatment to only those who need it most.

Dr. Steven Allen, a specialist in blood cancers at North Shore University Hospital in New York, recently treated a young woman who had suffered several relapses of a life-threatening cancer known as acute lymphoblastic leukemia.

Allen found a combination that involved thiotepa, an older drug his patient had not tried and could tolerate.

“When I ordered it, I was informed that there was none available, and it couldn’t be obtained,” said Allen, also chair of the committee on practice at the American Society of Hematology. He substituted a similar drug, but one that the woman had already taken. “We tried to make up a dose that was equivalent to thiotepa and hoped for the best. ... But I think it may have compromised her care.”

On May 14, the FDA announced it would allow temporary imports of thiotepa made by Italian company Adienne Pharma & Biotech, to relieve manufacturing delays at Bedford, Ohio-based Bedford Laboratories, a unit of the private German company Boehringer Ingelheim that is the only approved manufacturer for the United States. Bedford said in April it did not know when further shipments would be available once its supplies ran out.

Imports have not helped anesthesiologists like Dr. Jason Soch, who hears about a new shortage nearly every week during his rotations at several surgical centers in Philadelphia. These are often “workhorse” drugs such as fentanyl, midazolam and propofol, used every day during surgery.