Over the last year, there have been several articles and posts howling that drug warriors (a group I have no interest in defending) are harming patients by creating shortages of Adderall. It struck me as possible, but also as an awfully simple and convenient narrative for writers with a particular point of view on drug policy matters.
The Detroit Free Press recently published an article that offers a little more context. Medication shortages aren’t limited to Adderall or drugs with misuse potential.
Drugs in short supply more than tripled from 61 in 2005 to more than 200 this year, according to industry groups and the FDA, which lists drugs with shortages on its website — www.fda.gov.
The most critical shortages involve cancer, antibiotic, nutrition and electrolyte imbalance medicines, according to a fall report from the FDA.
Those used for neuromuscular conditions, anesthesia in surgery, pain and antiviral conditions also have had bad shortages, the report said. Some hospitals have had to postpone surgery because they didn’t have the right anesthesia drug, pharmacy groups say.
A U-M study found three different drugs are hardest to get: succinylcholine injections, a muscle relaxant used in surgery; dextrose 50% syringe medicine, to restore blood glucose levels, and epinephrine injections, used in cardiac surgery.
Further, there are multiple causes of these shortages:
The most common causes are manufacturing violations, production delays, shipping problems or ingredient shortages. The problem — called a national health crisis by federal regulators and leading industry groups — has worsened because of complex legal, regulatory, economic and other factors, according to a 2011 report from the federal Food and Drug Administration.
Shortages grow as generic manufacturers have consolidated and fewer plants are left making certain drugs, the FDA and others say.
The DEA is frequently blamed for the Adderall shortage, but this article suggests that there may be another side to the problem:
The DEA decides how much of the drugs can be manufactured each year based on the previous year’s prescriptions. It allots a percentage of that total production to each manufacturer and those firms are free to decide whether to manufacture generic or brand name forms of the drugs. The FDA blames overly strict manufacturing quotas for the shortages, but the DEA suggests pharmaceutical firms are choosing to make more of the expensive brand name pills than their generic forms.
Pharma and the DEA both have credibility problems, so I don’t pretend to know the truth, but it’s noteworthy that so many drug policy bloggers and reporters failed to provide this context. It would appear that their frustration with drug warrior hysteria and bias has led many of them to push their own biases in their writing.