Lake Houston - Humble - Kingwood Edition | June 2023

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A NATIONAL PROBLEM

“Those three—Albuterol, Adderall and Ozempic—are probably the most pronounced ones because they’re so commonly used right now,” Wollen said. big In Kingwood, Dr. Yusef Hassanali, a pharmacist at Greenpath Pharmacy, has seen the local eects 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 rst 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 Aairs 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 FOLLOWING THE SUPPLY CHAIN

Nationally, drug shortages peaked in the rst quarter of 2023 at 301, compared to the previous ve years, according to a national study conducted by the University of Utah Drug Information Service.

Number of drug shortages nationally by quarter

301

300 350 250 50 100 150 200

276

271

242

202

Q2 Q3 Q4

Q4 Q1

Q2 Q3 Q4 Q1

2018

2019

2020

2021

2022

2023

SOURCES: UNIVERSITY OF UTAH DRUG INFORMATION SERVICE, AMERICAN SOCIETY OF HOSPITAL PHARMACISTSCOMMUNITY IMPACT

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

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 dicult 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 dicult 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

Multiple parties—such as suppliers, manufacturers, wholesalers, hospitals and pharmacies—make up the supply chain for medications, according to the U.S. Food and Drug Administration, and disruptions can happen at any point along the journey, causing drug shortages.

Supplier : Provides components and ingredients

Manufacturer : Processes ingredients for pharmaceutical products

Wholesaler distributor (primary) : Purchases medications from manufacturers and distributes them to customers

Pharmacy or hospital : Can also include nursing homes, doctor’s oces, labs and clinics

Patient : 48.6% of people in the U.S. used a prescription

for medications to manufacturers

drug in the last 30 days from 2015-18.

Repackager : Moves medications into dierent containers without altering the product

Wholesaler distributor (secondary) : Independent pharmacies can seek out secondary wholesaler distributors when

SOURCES: FOOD AND DRUG ADMINISTRATION, U.S. ENVIRONMENTAL PROTECTION AGENCY, THE KAISER FAMILY FOUNDATION, CENTERS FOR DISEASE CONTROL AND PREVENTION COMMUNITY IMPACT

looking for out-of-stock medications

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