Nationwide drug shortages are affecting Sedgwick County emergency medical personnel who respond to 911 calls.
“We’re not in a crisis yet, but we intermittently teeter on the edge,” Sabina Braithwaite, medical director of Sedgwick County Emergency Medical Service, told county commissioners Tuesday.
Patient care has not been affected, officials say, because EMS has found other ways to get the drugs it needs. But the alternatives — mostly getting drugs at compounding pharmacies — have come at a higher cost.
The cost of an ambulance ride is all-inclusive. If drug costs continue to rise because of shortages, the county might have to consider a rate increase, said EMS director Scott Hadley. The last increase was in October 2011.
EMS gets weekly updates from its vendors about which drugs are in low supply, Hadley said.
“There’s no way to predict which medication will be next,” he said.
Braithwaite said 40 percent of drug shortages affect emergency care.
Drug shortages have been on the rise in the past decade.
“Here within the last two to three years, it seems to have hit EMS harder than it has in previous years,” Hadley said.
An executive order President Obama signed in 2011 said the number of prescription drug shortages almost tripled between 2005 and 2010 “and shortages are becoming more severe as well as more frequent.”
The president called for drug manufacturers to notify the U.S. Food and Drug Administration of impending shortages.
“Early disclosure of a shortage can help hospitals, doctors and patients make alternative arrangements before a shortage becomes a crisis,” the order said. “However, drug manufacturers have not consistently provided the FDA with adequate notice of potential shortages.”
Medications as simple as dextrose, which is sugar water used to treat patients whose blood sugar is dangerously low, are difficult to get in stock.
Sedgwick County EMS workers administer about 80 doses of the stuff a month, but the county has only received 30 pre-filled doses so far this year through its normal vendor, Braithwaite said.
Emergency personnel have been using vials of dextrose that they had to fill, “but we can’t get them at all anymore,” Hadley said.
“We’re now looking at compounding of those medications,” he said.
But that’s an expensive alternative. A pre-filled dose of dextrose costs $6.99. A vial costs $1.81. Pre-filled doses are preferred, Hadley said, because there is one less step for emergency personnel.
Compound dextrose costs $14 per dose and has a much shorter shelf life, 90 days compared with two years.
Hadley said EMS’ stock of dextrose vials “would get us through about mid-July at the current rate.”
The federal government also has responded by reducing the approval process time for generic drugs, among other steps.
Drug shortages have several causes, including production.
Ninety percent of generic drugs in the United States are made in one of three factories. Braithwaite said medical providers and retailers, afraid of running out of medicine to treat patients, are hoarding drugs. EMS also has ordered extra of some medications, such as epinephrine, which is used for cardiac arrest patients and has no substitute.
EMS for a while couldn’t get fentanyl, a pain medication given by IV, from its normal vendor. It typically paid $3 a dose for the drug. For a while, EMS had to get the drug from a compounding pharmacy, which uses raw materials to make a medication. That cost the county $6.50 a dose.
EMS now can get fentanyl again, Hadley said.
Ativan, used to treat seizures, typically costs $1.60 a dose. When the county could not get that drug, it turned to a compounding pharmacy that charged $8.50 a dose. Ativan is now available again, Hadley said.
Although more shortages are expected, “We have not run out of anything. I don’t anticipate us running out of anything,” Hadley stressed.