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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.


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

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Robin Young and Jeremy Hobson host Here & Now, a live two-hour production of NPR and WBUR Boston.

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