DAVID GREENE, HOST:
And we are learning more this morning about an opioid crisis different from the one we usually cover. This one is playing out in hospitals around the country. Anesthesiologists and other doctors are facing shortages of injectable opioids. These drugs, like liquid morphine and fentanyl, are used to control pain in critical care settings like surgery, intensive care units and hospital emergency departments. From Dallas, NPR's Wade Goodwyn has more.
WADE GOODWYN, BYLINE: In the pediatric intensive care unit at a major Dallas hospital, nurses attend to their small patients.
UNIDENTIFIED NURSE: You doing OK?
(SOUNDBITE OF HOSPITAL ROOM MACHINE BEEPING)
GOODWYN: These are critically ill children with both medical and surgical problems. The injectable pain medications morphine, hydromorphone and fentanyl are the mainstays of intravenous pain control and sedation in critical care settings. And across the country, hospitals and other medical facilities have been running low and out of the supplies they need.
RED STARKS: It escalated late this spring when we didn't have any morphine.
GOODWYN: Dr. Red Starks is a pediatric anesthesiologist who's been practicing for 26 years.
STARKS: One week, we had morphine, but we didn't have Dilaudid. And two weeks later, we've got a little trickle of Dilaudid, but we didn't have any morphine. And you're just thinking, hello, am I in the 21st century?
GOODWYN: Starks says that while there have been periodic shortages of pain medications in the past, it's never been this serious. Patients remain largely unaware of these obstacles to their pain management. Hi there, I just wanted to let you know we've been running low on pain meds is not the conversation starter anesthesiologists are going to use with their patients in pre-op. Of course, it's not just anesthesiologists who are affected. The number of medical situations where physicians use injectable opioids is considerable. But it's the anesthesiologists who are most distressed because it's their job to mitigate patient pain. Dr. Jim Grant is president of the 53,000-member American Society of Anesthesiologists.
JIM GRANT: Now we have it every day. We go in - what do we have today, what don't we have today? It's not unusual for me to get a call from the pharmacist, we have X number of this left, we're working on a somewhat of a contingency plan.
GOODWYN: Grant says in addition to Dilaudid, morphine and fentanyl, his members report shortages of bupivacaine, a local anesthetic, and the lifesaving drug epinephrine. Why? Well, pharmaceutical industry consolidation means where once there were many manufacturers, now there are a few. So a production interruption at any one plant can cascade into a serious shortage.
GRANT: We need more than one or two factories in a country of our size to be producing some of these essential drugs.
GOODWYN: You might think that if one drug manufacturing company is having serious production problems, it's an obvious opportunity for competitors. But the industry says that's not the way it works. Here's Matthew Kuhn, with the global pharmaceutical giant Fresenius Kabi.
MATTHEW KUHN: For a company like Fresenius Kabi to try and pick up the production slack from another company is complicated. Sterile injectable drugs are a complex manufacturing process to begin with, and then you have to increase production. You're essentially competing within your own factory for space and time.
GOODWYN: Still, Fresenius Kabi says it's trying to help.
KUHN: In the case of the injectable opioids, we have increased production. We have extended shifts. We have added workers. But one company is not going to be able to, you know, completely fulfill all the market needs for clinicians and their patients.
GOODWYN: Pfizer is one of those manufacturers that's had some production issues of late. Pfizer believes it's now got its problems resolved and, in a statement to NPR, said, we recognize the importance of these medications to patients and physicians and are committed to resolving these shortages as quickly as possible. So where's the federal government on all this? On the one hand, the DEA is trying to get a grip on an opiate addiction and overdose crisis that is killing thousands of Americans. So the DEA is trying to control supply.
On the other hand, the Food and Drug Administration is getting an earful from thousands of doctors, dozens of hospitals and, last but not least, 16 U.S. senators who wrote a stern letter demanding the FDA do something about this drug shortage, which the FDA would like to do, if it could. Here's Valerie Thompson, the associate director of the FDA's Drug Shortages department.
VALERIE THOMPSON: Well, I think one thing to remember is FDA doesn't control how much manufacturers make and can't order a manufacturer to make any product. So it's really up to the market to decide, you know, which drugs to make and how much.
GOODWYN: The FDA is concentrating on growing the number of suppliers, searching and expediting approval of additional sources, which is no easy task. You can't exactly buy sterile hydromorphone from the Keebler elves. Wade Goodwyn, NPR News, Dallas.
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