Hospitals across the United States are dealing with another kind of opioid crisis - limited access to injectable opioids. As a result, some hospitals and physicians have had to switch to using higher cost alternatives and in some cases delaying or canceling surgeries. Jared Brumbaugh reports on how hospitals in eastern North Carolina are affected by the nationwide shortage.
Injectable opioids are powerful pain-relieving drugs that are used in hospital settings for surgeries, injuries, burns and cancer. The narcotic medications work by altering the brain’s response to pain. Injectable opioids have the same compounds as prescription pain pills, but they metabolize much faster, said Genelle Butz, director of pharmacy with CarolinaEast Medical Center in New Bern.
"They give you relief of your pain a lot quicker. Some of them also wear off a lot faster which is why we use them in surgery because we can wake you up quickly from surgery without having a long duration of affect that you would see that you would see with an oral tablet that lasts a lot longer.”
Morphine, hydromorphone and fentanyl are the most common injectable opioids used in hospitals, but they’ve been hard to come by in the last several months for a number of reasons.
Pfizer, a major manufacturer of injectable opioids, halted production last summer after the Food and Drug Administration found several products were contaminated at a Kansas plant. Compounding the situation is that other companies aren’t able to make up for the shortfall because the Drug Enforcement Agency limits the amount of raw materials that manufactures receive each year.
CarolinaEast started to feel the effects of the shortage during the very active flu season, Butz said.
“We just came out of a fentynol shortage through the winter that was our biggest hurdle. Right now, we’re looking at morphine being our biggest hurdle to get through next.”
Butz said they’re trying to stay ahead of the shortage by using other medications like muscle relaxants for treating pain and stockpiling injectable opioids whenever they become available.
“We have two different people who keep a close eye on what’s available and if product is available at our wholesaler, we’ll obtain it. We place a lot of backorders which are supposed to be filled as new product comes in.”
Another reason for the shortage is a nationwide push to move away from using opioids. Instead, more and more hospitals are using non-steroidal anti-inflammatory drugs or NSAIDs to control pain.
“The providers have been using these drugs and reporting to me that they’re getting real good results.”
Byron Lee, pharmacy director for Onslow Memorial Hospital in Jacksonville said NSAIDs can be more effective and have fewer side effects than their opioid counterparts.
“Some providers [are] saying I think I may actually change my approach to dealing with treating a patient coming in with this particular condition, whether it be a broken arm or kidney stones or whatever. Providers are saying this approach is very good and I actually feel better about it because I’m not using an opioid.”
Onslow Memorial uses acetaminophen and ibuprofen infusions as an alternative to injectable opioids to relieve and reduce pain. While NSAIDs have some advantages, they can cost as much as four times the price of morphine, hydromorphone and fentanyl. In certain circumstances, some patients won’t respond as well to alternatives, resulting in inadequate management of pain, Lee said.
The shortage became apparent at Onslow Memorial back in December when they couldn’t refill their morphine supply. They switched to using hydromorphone and when that ran low, they began relying on fentanyl.
“It’s almost embarrassing to have to go down and start taking corrective measures and say well, the reason we’re doing this is because we can’t get morphine. Of course, then you have providers looking at you and saying well, what are we going to do?”
So far, Onslow Memorial hasn’t had to cancel or delay any surgeries. Lee said they’re responding to the shortage much like CarolinaEast: stocking up when supplies are available, placing backorders and conserving the injectable opioids they have on hand.
“We have started getting...being able to get morphine again... and hydromorphone again. Not in the quantities that we were able to get it before but we are slowly seeing an improvement.”
There are signs that the shortage might soon be letting up. While Pfizer isn’t expected to be at full capacity until 2019, the company has surrendered a portion of their DEA-enforced raw material allotment to three injectable opioid manufacturers to help mitigate the current shortage. This could allow hospitals in eastern North Carolina to have easier access to injectable opioids as soon as late June.
ENC Health Currents is sponsored by a special grant from Vidant Health and can be heard the first Wednesday of each month at 6:45 and 8:45 during Morning Edition on PRE News & Ideas.