At the end of the first quarter of this year, 301 drug shortages were ongoing nationwide, according to a University of Utah Drug Information Service report for the American Society of Hospital Pharmacists. This represents a 23% increase in drug shortages from one year ago.
Ongoing and active drug shortages are the most numerous they’ve been since 2014, according to the report.
Beginning in about October, some of the biggest drug shortages have been seen with Albuterol, Adderall and Ozempic, said Dr. Joshua Wollen, a clinical assistant professor at the University of Houston’s pharmacy practice and translation research department. The drugs are typically prescribed to treat asthma, attention-deficit/hyperactivity disorder and diabetes, respectively.
“Those big three—Albuterol, Adderall and Ozempic—are probably the most pronounced ones because they’re so commonly used right now,” Wollen said.
In Kingwood, Dr. Yusef Hassanali, a pharmacist at Greenpath Pharmacy, has seen the local effects of the shortages. He said Greenpath Pharmacy gets several calls daily from patients asking whether various drugs are in stock.
“It’s like we’re playing a game of ... cat and mouse here,” Hassanali said. “I get one thing and all of a sudden, something else will be on backorder.”
Most of the drugs in short supply are used by hospitals, Wollen said.
During shortages, acute care hospitals are usually first to receive drugs from manufacturers, but they can still be impacted, Kingwood Emergency Hospital CEO Jeremy Brynes said in a May 31 email.
“Hospitals will ... sometimes become much more selective about ... how we utilize the medications and who will receive it,” Brynes said.
Ongoing shortages
A March report from the U.S. Senate Committee on Homeland Security & Governmental Affairs asserts that drug shortages are “increasing [and] lasting longer.” The average drug shortage lasts 1.5 years, and new drug shortages increased by 30% from 2021 to 2022, according to the report.
As of March 31, the class of drugs in shortest supply nationally were central nervous system drugs, such as Adderall, according to the University of Utah Drug Information Service. The second highest was antimicrobials, such as amoxicillin.
Adderall is a controlled substance used to help improve the focus of patients diagnosed with ADHD. The U.S. Food and Drug Administration added the drug to its shortage list on Oct. 10, according to the agency’s website, with multiple manufacturers citing “demand increase” or “active ingredient” shortages as causes.
The drug shortage has proved challenging for prescribers too. Dr. Sunanda Muralee, a child psychiatrist at Menninger Clinic, said she’s been dealing with shortages for ADHD medications, including Adderall and Concerta, during the last year.
“Knowing that there is a national shortage, it ... makes it like 10 times more difficult as a prescriber. ... You’re always thinking, ‘Wait, should I prescribe this?’” Muralee said.
Large and small medical wholesalers alike have frequently run out of needed medications during the last two to three years, Hassanali said, forcing pharmacists to track down alternative suppliers. Adderall has been on backorder for the last six months, Hassanali said, and since it’s a controlled substance, independent pharmacies are capped on the amount they can purchase each month.
“I’ve been trying ... to call pharmacists around and see if they have [drugs] in stock and then transfer the prescription over there so that the patient goes to another pharmacy,” Hassanali said. “Then we lose that income.”
Some medications that have been difficult to obtain, such as children’s antibiotics, are not useful to patients if they are delayed, he said.
Supply and demand
Drugs typically pass through multiple parties—such as suppliers, manufacturers, wholesalers, hospitals and pharmacies—in the supply chain before they end up in the hands of patients, according to the FDA. Disruptions can happen at any point, causing medication shortages.
“There are many reasons for medication shortages,” Brynes said. “Shortages in raw materials used in manufacturing, challenges with medication quality, manufacturing delays and discontinuations are just a few [examples].”
For 2022, 19% of drug manufacturers blamed supply and demand for U.S. medication shortages, and 18% cited manufacturing issues, according to the University of Utah Drug Information Service. Meanwhile, 56% of manufacturers did not know the cause or would not provide a cause.
Rises in access and demand led to the Adderall shortage, Wollen said.
“People are able to get seen and get treated for mental health issues much more readily, and so that has caused the increase in demand that the supply chain didn’t have enough to keep up with,” Wollen said.
Waiting for relief
Doctors and pharmacists can prescribe alternate medications if one runs out, but the changes can be difficult for patients, Wollen said.
“Patients ... are usually pretty frustrated and understandably so. ... There’s some people that can’t afford ... [to take] a half day of work trying to chase around town and find out who has their drug in stock,” Wollen said.
For the last year, Summerwood resident Jennifer Arnott has been driving to a pharmacy about 28 miles away from where she lives to get her prescription thyroid medication. Arnott has taken Levoxyl for about 10 years, and she said she does not do well on substitutes for the medication.
“It’s a pain, but there’s nothing that you can really do,” Arnott said.
Experts are unsure when the shortages will end. Brynes said demand always ebbs and flows for various medications.
“Often times medications that are used ‘off label’ might be a fad—such as medications with weight loss as a side effect—and with time ... [as] the pros/cons of using certain medications ‘off label’ becomes more widespread; demand wanes,” Brynes said.
Hannah Brol contributed to this report.
