Because of the shortages, "we've had deaths … we've had medication errors," says Michael Cohen, a pharmacist and president at the nonprofit Institute for Safe Medication Practices in Horsham, Pa. As an example, he referred to the case this year in Alabama where 19 patients were seriously infected and nine died because a standard, premixed solution for IV feeding tubes wasn't available, so a pharmacy mixed its own and it was contaminated.
Drugs now in short supply — often given by injection or intravenously to patients in the hospital — are prescribed for a wide range of medical problems including cancer, allergies, heart disease and infectious diseases. Shortages involve some anesthetics for patients having surgery and "crash cart" drugs for emergencies — like epinephrine injections used to restart the heart — and even electrolytes for patients fed intravenously.
Johnson & Johnson recently warned doctors not to start cancer patients on Doxil, a widely used chemotherapy drug used to treat ovarian cancer and multiple myeloma.
At the nationally known M.D. Anderson Cancer Center at Houston, the supply of the thyroid cancer drug Thyrogen (thyrotropin alfa) was so tight by mid-July that the cancer specialists began triage — giving patients the drug according to the severity of their case, says Wendy Smith, a clinical pharmacy manager there.
The Thyrogen shortage, Smith says, "puts us in a new frontier where we are actually delaying [treatment] in situations where there is no drug alternative."
Beth Frank, who lives in a suburb of Dallas, was diagnosed two years ago with a rare and aggressive form of thyroid cancer. In June, she was scheduled for her third radioactive iodine treatment, designed to kill any remaining, scattered cancer cells.
But the 50-year-old administrative assistant has been waiting two frustrating months for the procedure — now scheduled for mid-August in a local hospital — because Thyrogen wasn't available. The drug helps thyroid cancer patients avoid the sometimes severe side effects — including depression, fatigue and pain — of hormone withdrawal.
Genzyme, the manufacturer of Thyrogen, said it anticipates supply disruptions to continue into 2012.