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American Association of Oral and Maxillofacial Surgeons

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Drug Shortage is a national public health problem

February 22nd, 2012

A growing shortage of important chemotherapy drugs, anesthetics (including diazepam, midazolam, and fentanyl) and antibiotics, which has compromised or delayed care across the United States, has become a national public health problem.

The American Hospital Association notes that more than 90% of AHA surveyed hospitals reported shortages of surgery and anesthetic drugs; 82% of the surveyed hospitals reported delaying treatment and 69% reported providing less effective treatment.

Hospitals, unlike oral and maxillofacial surgery offices, have some alternatives, such as using compounding pharmacies. They are also more likely to receive supplies when they become available because they are high volume customers or part of a purchasing group.

Some Reasons for the Shortages

In general, factors contributing to the ongoing drug shortage include:

  • Consolidation of generic drug production with fewer manufacturers
  • Aging facilities with limited incentive (pricing) to upgrade or expand capacity
  • Quality/contamination
  • Shortage of active ingredients
  • Stockpiling
  • Domino effect (use of alternatives leads to shortage of the alternative)

In addition, the January 11, 2012 issue of JAMA found, "The common denominator for problems with these drugs is that they are older, off patent, difficult to formulate, and have a defined shelf life."

The US Government Accountability Office, which has prepared a report entitled "FDA's Ability to Respond Should Be Strengthened", and the FDA, whose Web site offers an extensive FAQ section on the drug shortage, are two excellent resources for gaining a better overview of this problem. In addition, AAOMS recommends the American Society of Health-System Pharmacists Web site as a comprehensive source for information about specific drugs and possible alternatives.

Alternatives

AAOMS has learned that the pharmacy boards of Texas and Arkansas allow pharmacy compounding of unavailable FDA approved drugs. If you are considering the use of compounded formulations of unavailable drugs, check with your state pharmacy board to make sure that any out-of-state pharmacy from which you order has a non-resident pharmacy license in your state. Also, consider contacting your liability carrier to determine if there is a coverage issue related to the use of compounded drugs.

Advocacy

The AAOMS Department of Government Affairs is involved in legislative and other advocacy initiatives to help alleviate this crisis and avert future shortages. For information on AAOMS advocacy activity, please contact the Department of Government Affairs at 800-822-6637.