The drug shortage crisis in the United States: causes, impact, and management strategies.

patient care when prescribers must use an alternative agent,” whereas the FDA focuses only on “products used to prevent or treat a serious or life-threatening disease or medical condition for which there is no other available source with sufficient supply of that product or alternative drug available.”2–5 The Drug Information Service at University of Utah Health Care (UUHC), which partners with the ASHP to manage its drug shortage program, tracked a total of 211 drug shortages in 2010—the highest number recorded to date in a single year (Figure 1).3,6,7 By comparison, the ASHP identified 224 drug shortages during the entire six-year period between January 1996 and June 2002.3 An analysis by the Premier Healthcare Alliance in March 2011 also found that more than 240 drugs were in short supply or completely unavailable in 2010, and more than 400 generic medications had been back-ordered for five days or more.8 The number of drug shortages has been rapidly escalating in recent years; ASHP/UUHC reported 70 in 2006, 129 in 2007, 149 in 2008, and 166 in 2009.4,9 For 2011, there have been 210 shortages reported as of September 15. At the time of this writing, 203 drugs were listed on the ASHP/UUHC drug shortage Web site and 73 medically necessary drugs were listed on the FDA Web site.10,11 Although certain types of drugs are more vulnerable to shortages than others (such as generic cancer drugs), shortages of a variety of drugs have been reported, including heart drugs, pain medications, intravenous (IV) electrolytes, and many others.6 Drugs that have been around for decades are suddenly not available, which can significantly affect patient care.12 These include leucovorin, propofol, morphine, hydroThe Drug Shortage Crisis in the United States Causes, Impact, and Management Strategies