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Wednesday, August 8, 2012

Drug Shortage Leads To EMTs Carrying Expired Medicines

Salem fire department paramedic Jennifer Pratt checks over medications in an ambulance in Salem, Ore., Tuesday, July 10, 2012.  (AP Photo/Don Ryan)

Salem fire department paramedic Jennifer Pratt checks over medications in an ambulance in Salem, Ore., Tuesday, July 10, 2012. (AP Photo/Don Ryan)

To help first responders deal with drug shortages, Oregon has taken the unusual step of temporarily allowing ambulance services to carry and administer expired drugs.

This rule change took effect last month, but the AP reports that paramedics in the city of Bend, OR have been using expired drugs for a year.

And Oregon isn’t alone. The drug shortage crisis is hitting the whole country. Some blame a regulatory crackdown by the FDA. The FDA disputes that claim, and says the shortage is due to manufacturing and quality problems. And others say there’s little incentive to make generic drugs because of a low profit margin.

Shortages Across The Board

“Unfortunately, we are at such a shortage of critical medicines and emergency care across the country,” says Dr. Jim Augustine, “that we have to expand our supply somehow. And one of the resolution methods is to use drugs that are passed the manufacturer’s expired dates.”

Dr. Augustine says shortage is on the manufacturing side, so ambulances and hospitals are facing the same shortages in emergency drugs: from Valium to treat seizures or Dextrose-50 to boost a diabetic’s blood sugar .

“Every class of medicine that we use in emergency care is short,”  says Dr. Augustine. “The count of medicines this week that are short, there are 59 medicines that we use in emergency care. And 170 preparations of those 59 medicines are on the report this week are medicines that we cannot access — we can’t purchase. So our supplies from the manufacturers have dried up all the way through the system to the point where we cannot purchase those.”

Manufacturer’s Expiration Dates

A 2003 study by Harvard Medical School found that 90 percent of drugs, including prescription and over the counter drugs, were good to use even 15 years after the expiration date. But the article is quick to point out that effectiveness and potency does degrade over time.

Dr. Augustine says there’s been a long time disagreement on the accuracy of a medicine’s printed expiration date.

“With consumers, you sometimes are not sure that the medication has been kept in a safe, clean, dry, climate-controlled place. The hospital pharmacists insist that because medicines in hospitals and in their warehouses are kept in very controlled circumstances, that their lifetime is well beyond posted expiration dates.”

Augustine says the federal government keeps emergency stockpiles of drugs long past their expiration date with intermittent testing. This testing shows that many medications keep full potency after the manufacturer’s expiration date.

“Many medications, especially the simple compounds that are put in nice glass containers that protect them from any kind of degradation, they are no doubt still very safe and very effective years after the manufacturer’s posted expiration date,” says Dr. Augustine.

Reality In The Field

Dr. Augustine says first responders would not make the decision to use expired medications on their own. But some state and local governments are giving them the go ahead if they decide that having expired medicine is better than having no medicine at all.

“And that’s where Oregon, and Las Vegas and other communities have come to a rational decision: rather than having no medicine available at all, we will put supplies of medicines out that we are sure are still safe, and that will be used in emergency patient care beyond that posted expiration date,” says Dr. Augustine.

Guest:

  • Jim Augustine, emergency physician and medical director of Emergency Services in Atlanta Georgia

Please follow our community rules when engaging in comment discussion on this site.
  • Retired Pharma Executive

    Expiration dating for drugs are set according to FDA requirements.  For example, to get a 3 year expiration date, manufacturers must test the drugs, which are stored at controlled conditions, at time points up to 3 years to demonstrate that they do not lose potency.  If most of the batch is sold and used in less than 3 years, it does not make sense to test for a longer period of time to extend the expiration date to four or 5 years, since that adds extensive analytical testing.  It is true that many drugs remain potent beyond their labeled expiration date, but there is no guarantee.

  • Jdsmullen2

    A related issue to drug shortages:  when my brother-in-law, in hospice care, passed away last September, he had hundreds and hundreds of pills of various types from morphine for pain to meds for his digestion and bowel movements.  Some had been delivered in generous amounts earlier the day he died.

    From what the nurse told me, ALL of those meds would be destroyed — thousands of dollars worth, some, I’m sure, now in short supply.

    Knowing that drugs need oversight and control, is there NO WAY to make use of these drugs that people around the world, in addition to Americans, have little access to?

  • Brenda Coleman

    Dear Here and Now,
               My dad, a conscientious and hard-working internist who practiced medicine from the 1950s through the 1980s in central Texas, confided to me decades ago that he thought medicine-expiration dates served more to help pharmaceutical companies sell products than to protect patients from ineffective medicines. Since then, I’ve taken lots of medicines long after their expiration dates–after storing the medicines all the while in a dark, cool, dry place–and I’ve never suffered any problems. I know that my parents (my mom was a registered nurse) did the same. My mom lived to age 86 and my dad is still healthy and strong at 90.
              Brenda Coleman
              Chicago

    • SusanB

      Ditto, Brenda. I’m still not finished with  a bottle of generic anti-anxiety pills that go back to 2005, and, as far as I can tell, they haven’t lost a bit of effectiveness. (   Obviously, I don’t take them often   :-)   )

  • NNFD firefighter/medic

    Im a firefighter in newport news, va – a coastal city of close to a quarter million.
    We are experiencing the same shortages as everyone else. The challenge of the drug boxes your guest described is that when we check off our trucks each morning, we don’t get to open the locked containers unless it is to administer meds. So we have no idea what the packaging is going to be, concentrations, or whether what we are hoping to use will even be inside.
    Not an ideal situation in circumstances when timely drug administration can truly mean life vs death…

  • BeantownMedic

    I am a Boston-area paramedic. Although our area has been fortunate to be spared the brunt of these shortages, it has become difficult to source some medications over the last month. At times we are exposing our patients at a greater risk when having to adjust medication concentrations by hand for certain purposes. We are now using Valium-alternatives, which themselves have also gone into shortage. If these shortages continue, our options will undoubtedly disappear. I know that our service is not able to maintain supply on a daily basis without stockpiling, something which also allows us to “bargain” and trade with other agencies.

  • Dr K

    I am a Doctor of Pharmacy practicing for over 12 years as a clinical hospital pharmacist. I am disappointed that you did not involve a hospital pharmacist in this discussion as we are on the front line of drug shortages and are the health care professionals who are responsible for finding therapeutic equivalents for the extensive list of medications hard to obtain or are unavailable.  Having a practicing hospital pharmacist involved in this interview would have broadened this discussion and added a perspective that was not included.

  • Sowdal

    Planned to defeat health care change, typical right wing fear tactic

  • Sueazar

    I would like to hear a follow-up on this story! Just WHY are drugs in short supply? ( Manufacturers’ monopolies, they’re not making enough profits….) Also, can the US import drugs from other manufacturers abroad, or are we bound to the local manufacturers by ‘exclusive’ contracts?

    • Kat

      Drugs can and are imported from other countries, so long as the manufacturer has been inspected by the US FDA and are in compliance with regulations.  You’d probably be surprised how many drugs that you take are imported.

  • homebuilding

    This is one more item in the outline:  The Third-Worlding of the USA

    Could you make a couple of calls to Windsor, ON and Vancouver, BC
    Do they have better access to drugs that may be difficult to obtain in
    Detroit and Bellingham?

    If any of the drugs (that are difficult to obtain in the USA) are now readily
    available in Europe, Canada, and Japan–
    well it tells us a great deal about:
    –how wonderful our health care system really isn’t, and
    –how impotent the free market is in solving our problems

    Note that one drug discussed in the various narratives (Valium=diazepam) is
    commonly prescribed to control seizures (which can be caused by any type
    of brain insult, be that trauma, intra-cerebral “electrical storm,” or nutrient
    imbalance.  It’s dead cheap and

    THERE IS NO EXCUSE FOR NOT HAVING THIS DRUG AVAILALBE

    PERIOD

    This story is a great national SHAME

  • http://profile.yahoo.com/LB5L5SXJFDLJ75TNSOYSGGEOWM Missioli

    We need to establish a policy on the salvage of drugs and medical equipment/supplies from patients who no longer need them. For example, my family was left with a large amount of properly stored, sealed, unopened expensive drugs and medical supplies after a family member passed.  I couldn’t find anyone willing to take them. This is a pretty common experience in my mid-Michigan community. It would seem that there should be another option other than the destruction of these valuable commodities.

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