LEWISTON — For years, hospitals have struggled with drug shortages. A lack of antibiotics here, not enough sedatives there.

But recently, shortages have skyrocketed from 61 drugs nationally in 2005 to 178 in 2010. Current shortages for Lewiston hospitals include cancer and epilepsy medications.

It’s gotten so bad that Maine Republican Sen. Susan Collins wants manufacturers to alert the Food and Drug Administration of any incident that could cause a shortage.

“I have met with several doctors and medical professionals in Maine who are very concerned,” Collins said in a prepared statement. “They told me that these shortages are causing serious problems around the country, including forcing some medical centers to ration drugs or postpone elective surgeries.”

She said, “It is scary enough for a cancer patient to have to go through chemotherapy, but to be told that there’s a shortage of a drug that they desperately need is just devastating.”

Drugs can be in short supply for several reasons. The manufacturer of a name-brand drug might cut production, assuming other manufacturers will start making a generic counterpart, but those generic manufacturers don’t produce as expected. A maker might go out of business, have production problems or need to order recalls.

The FDA might shut down a manufacturing plant that doesn’t follow regulations or has had issues with quality. And what might start out as a small supply problem may be made worse by buyers who snatch up large quantities of drugs in anticipation of a major shortage.    

Manufactures sometimes handle shortages by rationing drugs when demand exceeds supply. But generally, it’s up to doctors and hospitals to figure out a way to deal with a shortage. Nationally, some hospitals have come to rely on a “gray market,” middlemen who sell scarce drugs at very high prices.

Central Maine Medical Center and St. Mary’s Regional Medical Center in Lewiston  say they don’t use that gray market because they can’t guarantee where the medications come from or that the drugs have been stored properly. But that means both hospitals have had to figure out their own way to deal with shortages.

It’s not easy.

Last year, CMMC ran out of a drug that paralyzes a patient’s muscles during surgery. It was scarce nationally and the hospital wasn’t sure when it could get more.

“If you need it for surgery and you have some surgeries scheduled, you can either delay surgeries or transfer people elsewhere where the drug is available,” said Phil Rioux, CMMC’s pharmacy director.

The hospital considered transfers, but that turned out not to be necessary. Four hours after it ran out, CMMC got a shipment of the drug. It was a lucky turn of events.

But the hospital could run out of another drug and officials know it. When medical personnel log into CMMC’s computer system, the first page alerts them to drug shortages. This week, the page detailed shortages of cancer drugs, anti-nausea medication, epilepsy medication and an antibiotic that’s been on long-term back order and is sent by the manufacturer only for desperate cases. It takes that manufacturer three days to decide whether a case is desperate.

That’s a long time to hold off on an appropriate antibiotic, Rioux said.

Hospitals substitute drugs when they can, but that isn’t always possible, particularly when it comes to cancer treatment. 

“There are some cancer drugs that have been in very short supply,” Rioux said. “Sometimes, therapy has had to be withheld or delayed because of it.”

St. Mary’s hasn’t had to move patients or cancel surgery, but officials said the hospital has come close. It gets drugs from other hospitals when it has to and it keeps doctors informed of supplies using newsletters, notices, phone calls and meetings to keep them up to date and to offer substitutes.

“That’s the first line on the agenda: shortages,” said pharmacy Director Marc Boissoneault.

For St. Mary’s, part of the problem is that it never knows which drugs are going to suddenly be in short supply, so the hospital generally can’t plan ahead.

“The thing is, we get no warning that a company has closed down until a month later when there’s a shortage,” Boissoneault said.

Both he and CMMC’s pharmacy director believe Collins’ proposal might help. The bill, co-sponsored with Sens. Amy Klobuchar, D-Minn., and Bob Casey, D-Pa., would require drug manufacturers to give the FDA a six-month notice before a stop in production. For unexpected production issues, the bill requires that they alert the FDA “as soon as possible.”

The bill has been referred to a congressional committee.

“It won’t solve it, but I think it would help,” Boissoneault said.

ltice@sunjournal.com

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