Are There Any Drugs Left?

Near Iguazu Falls, Argentina - photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com


PATIENT ALERT!

Are you nervous on surgery day and would like some intravenous sedation to calm the nerves? Usually this is not a problem; just squirt some Ativan or Versed into the IV, and all that apprehension and memory passes away.

How about the terribly unpleasant side effects like nausea and vomiting? Thank goodness Zofran, Reglan, and Protonix can quiet the stomach.

Having trouble breathing due to fluid in the lungs due to congestive heart failure? Lasix and Bumex are powerful diuretics which rid the body of extra fluid and restore respiratory function.

Propofol may be Michael Jackson’s recreational drug of choice, and one he had no trouble acquiring. However, until recently there have been acute shortages of this crucial drug. When Propofol supplies waned, anesthesiologists substituted Etomidate to put patients to sleep for surgery.

These signs and symptoms are serious matters but pale in comparison to pain. Intravenous Dilaudid, Fentanyl, and morphine are the mainstay for the treatment of acute pain. Demerol is effective as well, but due to some rare side effects plaintiffs’ attorneys have made it a “pain” to use. Whether a law suit has merit or not, hospital administrators find it far easier to restrict the use of a drug rather than fight for it in court.

Long acting and inexpensive local anesthetics, such as Bupivicaine, can be used for nerve blocks to greatly reduce painful surgical conditions.

Here’s the bad news: all of the bold typed medications are in short supply. They represent many of the primary medications used to treat medical and surgical patients. Most are not expensive and have been used for decades, but now are scarce due to production difficulties, mandatory government regulations which promote waste, and legal hurdles erected by “caring” personal injury lawyers.

There is an irony in all this. Only a few years ago regulatory agencies touted pain as the fifth vital sign, along with blood pressure, heart and respiratory rates, and temperature. The word was out: patients were under medicated and unduly suffering. Every physician from surgeon to psychiatrist and ophthalmologist to anesthesiologist was required to acquire continuing medical education to increase awareness and proficiency. Flaggers were not tolerated; medical licenses were at stake. Now narcotic drugs necessary to deal with the fifth vital sign are not readily available.

We practitioners are encouraged to use substitutes, and we are resourceful by nature. However, there are only so many rabbits which can be pulled from the hat. I wonder if the political aristocracy will accept second rate drugs when they are vomiting their guts out, struggling to breath, and suffering from intractable pain?