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?

Putting Your Head Where the Sun Don’t Shine: More Drug Shortages

Butterfly near Iguazu Falls - photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

“Harriet, throw the rest of that gallon of milk away! And while you at it, get rid of those extra steaks, too.”

“Honey, I just bought the milk today, and the kids only drank a quart of it. The steaks are fresh, and I couldn’t buy less than ten pounds at Costco.”

“You heard what I said. The rules say once something is opened, you can’t save what you don’t use the first time around.”

“But, Ronald, the kids are hungry, and food isn’t cheap anymore. It just isn’t right to waste it, especially since I’ve made sure it’s safe to eat and the expiration date is days away.”

“Don’t argue with me. You should do as your told and listen to Harry and Nancy. They know what’s best for us.”


In the past year there have been shortages of many of the mainstay drugs used in the practice of anesthesiology. Fentanyl, versed, metoprolol, pancuronium, labetalol, propofol, ranitidine, wydase, and morphine used for spinal anesthesia at one time or another have been in short supply. Sodium pentothal is no longer available. These are not experimental drugs which were introduced recently to clinical medicine, nor do they require ultra sophisticated technology to produce. There is a lot of finger pointing, and we are told manufacturing problems, lack of raw materials, and hoarding are to blame. There is one glaring omission, and the prime culprit is ironically the avowed champion of public safety, whose regulations generate much of this enormous amount of waste.

Clinicians have no control over production problems, but they are the best resource to insure drugs essential for the best care of their patients are used in a prudent fashion. With regard to narcotics such as fentanyl and spinal morphine and amnesia drugs like versed, government agencies mandate any amount of sterile drug left in a container be wasted. Even though the drug is not contaminated and the expiration time has not arrived, it must be thrown in the trash.

The cost of such an inane policy is two fold: hospitals must use repackaged drugs which can increase the cost ten fold, and patients are deprived of medications which optimize their care.

Besides receiving the appellation “senior," one of the advantages of a long career in medicine is the extended view. Trends and policies come and go. Some are beneficial to patient care; many are not. The proliferation of rules and documentation which goes along with them qualifies for the latter. Bureaucrats’s careers are built on this silliness, and there seems to be no end to the intrusion. Politicians and their minions have insinuated themselves into the most minute cubby holes of health care. The reason given is always patient safety and cost efficiencies, but it is just as much about control and the furtherance of careers. Whisk away the rhetoric and the egos, and just like the mindless wasting of drugs, most of these “improvements” are expensive, defy common sense, and are down right immoral.