Clueless in D.C. - The National Drug Shortage

Thistle at Tinhorn Ranch, California - photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

We can’t throw the drugs away fast enough. It makes no difference if there is a national shortage or patients are deprived of them; we dispose of them anyway. The heart of the problem is the state hospital inspectors and the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) whose regulations force hospitals and doctors to waste millions of dollars worth of medications annually. The situation would be the stuff of high comedy if the implications were not so serious. Depending on the source of information, last year alone there were about 200 drugs in short supply - three times the rate as five years ago.

In the operating room it is no coincidence the number of drugs which are difficult to acquire parallels a similar increase in the level of governmental intervention in the daily practice of medicine. The intensity of control goes far beyond the purported goal of patient safely and insinuates into every aspect of care for the surgical patient. Just as the supply of ammunition can be used to restrict 2nd Amendment rights, control of the pharmacy is the key to undermining the independence of hospitals and physicians.

Most medications used in surgery contain preservatives. As long as the container is accessed in a sterile fashion, the expiration date of that particular drug is not exceeded, and a separate syringe is utilized for each dose then the drug can be safely administered to multiple patients. By adhering to this protocol, needless waste of valuable resources is avoided.

How much do we waste? In the operating room often as much medication is discarded in the trash as administered to patients in order to comply with state and JCAHO standards. When playing by the book and using a system which electronically dispenses all medications, it is not uncommon to use only 10-20% of a drug contained in a multi dose vial. This includes controlled substances like narcotics and others which have no abuse potential but are essential in surgery.

The Obama Administration ordered the FDA to address the problem by emphasizing increased production of drugs and cutting red tape to make them more available for patient use. A less expensive but more expeditious and effective tactic reins in regulators whose rules promote waste and scarcity. Ignoring the obvious solution will sustain current policy which insures the drug companies sell a lot more drugs than are actually needed and forces patients to compete with the garbage disposal for medications. In the meantime physicians must ask if bureaucratic regulations which force them to senselessly destroy medications are in conflict with the moral obligation to do what is best for their patients’ welfare.