How can we navigate injectable narcotic shortages?

By Todd Ebert

Despite some progress and a decline in the number of new shortages, critical drug shortages continue to jeopardize patient access to medications. These shortages have been exacerbated by several natural disasters and some manufacturing delays that have occurred over the past year. Healthcare group purchasing organizations (GPOs) are important partners in helping hospitals and providers navigate these drug shortages to provide patient care. Our unique line of sight into all aspects of the healthcare supply chain allows us to help our healthcare provider customers anticipate and navigate ongoing drug shortages.

Recently, a manufacturing delay caused hospitals and other healthcare providers to experience critical shortages of a number of injectable narcotics that are an essential element of treatment for post-surgical and medical pain management. If hospitals and providers don’t have the necessary injectable opioids available, many medical procedures will have to be postponed or cancelled, jeopardizing the well-being of patients across the country.

Other manufacturers who were willing to come to the table to produce these medications to help mitigate the shortages were initially unable to do so due to DEA production quotas for narcotics. Many organizations, including the Healthcare Supply Chain Association, publicly called on the DEA to temporarily adjust production quotas to allow the other manufacturers to step in. The DEA subsequently did lift the production quotas for certain manufacturers, an important step for mitigating potential shortages.

Controlling narcotics use – particularly outpatient prescription opioid abuse – remains a public health priority, which HSCA supports. The DEA recently issued a proposed rule on opioid production limits. In recent comments to the DEA, HSCA offered recommendations to help control narcotics use while also protecting provider access to injectable opioids, which are critical to patient care. Those recommendations included:

  1. Differentiating oral opioids and inpatient/injectable opioids. HSCA and its members share DEA’s commitment to reducing opioid diversion; however, when making adjustments to production limits, the DEA should differentiate between outpatient/oral opioids and those injectable opioids used in an inpatient hospital and healthcare provider setting. Injectable opioids are critical to a wide variety of practices in the inpatient setting where it is not clinically appropriate to use oral opioids, including for treatment of some acute and chronic pain; sedation; pain management and in intensive care units.
  2. DEA should outline a process for quickly adjusting production quotas in the event of shortages. The DEA should outline a process for quickly identifying and rectifying potential problems, including a timeframe for how quickly the DEA will move to adjust production quotas in the event of potential shortages.
  3. DEA should use available data to inform decisions about adjustments to quotas. DEA already has access to information that would be helpful in addressing production quotas in the event of drug shortages. As such, the DEA should establish processes to ensure that all available data is being used in a timely fashion to help anticipate and address potential shortages.

HSCA and its members will continue to work with the administration, hospitals, and all healthcare stakeholders to mitigate drug shortages and identify solutions to protect patient access to care.

Todd Ebert, R.Ph., is president and CEO of the Healthcare Supply Chain Association (HSCA).

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