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February 9, 2012 / Jackie H. Burns

Back-ordered Medications–Again?

This week a critical shortage of methotrexate–a chemotherapeutic agent used to treat certain cancers in human children–has been in the news.  They say there is only a “two week supply” left.  And without it, babies and children with Acute Lymphoblastic Leukemia will die.  While our veterinary supply issues with shortages and back orders is frustrating to me, it pales in comparison to parents who face losing a precious child because of the shortage of methotrexate.  My heart goes out to these people.  And so I have updated this blog, which I originally published last week.

We veterinarians have been facing some availability issues with certain medications.   One article I read recently referring to shortages within human medicine reports that 267 new drug shortages were reported in 2011, with most remaining unresolved.  I suspect the veterinary pharmaceutical roulette wheel is spinning even more out of control.

The situation has gone from mildly annoying temporary shortages to being totally ridiculous.

Way back in the 80’s when I entered the profession, most drugs and medications were available almost all the time.  Occasionally, something would be back-ordered for a few days.  Rarely, a product would be taken off the market.  Often, it was because a better medication had come along–something superior or stronger or with fewer side effects.  A true improvement for our patients and our profession.

Unfortunately, in the last three or four years, the drug availability problem has escalated.  Drugs and other essential products seem to disappear from U.S. suppliers in the blink of an eye.  Sometimes things our patients depend upon are back-ordered for weeks or months.  Some medications are back-ordered indefinitely.  And some are taken off the market outright.

Right now, the majority of ophthalmic ointments–the mainstay of primary veterinary eye care–are unavailable in regular U.S. markets.  You can’t imagine how frustrating it is for me to unable to get a moderately priced eye ointment for pets, something that about 70% of young kittens need during their first months of life.

The only thing more annoying than this is going into a feed and seed store and finding the same product retailed there for less than I would pay for it wholesale IF I could find some to buy.

One of our important anesthetics is currently back-ordered, supposedly “for months.”  It is also used as a muscle relaxer, an appetite stimulant and for epileptic seizures.  A common cancer chemotherapy drug has been sporadic in availability for over a year.  It’s frustrating for me and could be a life and death matter for the patient that needs it.  And believe it or not, there have been times when I have been unable to get euthanasia solution.  Even something as simple as helping to end a life in a pain-free and dignified matter is sometimes complicated.

The  drug recommended for treatment of adult heartworm infections is off the market and has been for months. The American Heartworm Society has changed its recommendations to accommodate this temporary inconvenience and I have adapted my protocols.  Recently the manufacturer has been granted permission from the FDA to temporarily import some from European suppliers.

And now that I can actually get my hands on something with which to treat heartworms, my mainstay heartworm preventative is unavailable.  It’s enough to make me want to pull my hair out!

What is the cause of all of these shortages?

Raw Material Availability

Industry insiders indicate that some availability problems relate to raw material shortages.  In fact, when a very good pet insulin product was recently taken off the market, the industry blamed it on a shortage of beef and pork pancreas used in its manufacture.  Oh, really?  Right, like slaughterhouses aren’t turning out a few hundred thousand of those by-products a day?  Give me a break.

Quality Control Issues at Factories

Another common cause of product supply chain interruption is factory shut- down either by the FDA or “voluntarily” due to quality control issues.  For example, it is rumored that a quality control issue with a human over-the-counter analgesic is the reason why I can’t get a certain dog drug right now.  The products are manufactured in the same factory.  If the plant is shut down for quality control with one product, other products made in the plant also go offline.

Sometimes the quality-control issue is unrelated to product integrity.  It may be related to the packaging or even the labeling.  Last year a popular flea product was taken off the market because of an issue with the sprayer nozzles.

Economic Factors

Let us also place blame on the almighty dollar.

Whereas pharmaceutical companies are willing to invest billions on researching and marketing drugs for erectile dysfunction in human males and cholesterol lowering drugs for fast-food fueled Americans, they are not going out of their way to keep a production line open for generic kitty eye ointment.   While it is important to me and important to the cats that have eye infections, that share of the market is financially insignificant.

I sense that the situation with medication availability is only going to get worse.  If it feels like we–your primary care veterinarians–are juggling products in order to provide what your pet needs, it is true.  We can’t help it.  We’re trying to do the best we can.

~Jackie H. Burns, DVM

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