California Hospitals Grapple With Shortage Of Powerful Opioid Painkillers

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As President Donald Trump announced Monday that he wants doctors to write fewer prescriptions of highly addictive opioid painkillers, hospitals across the country continued to grapple with a different opioid crisis: a shortage of injectable morphine, Dilaudid and fentanyl.

The drugs, which are administered to patients undergoing surgery, fighting cancer or suffering traumatic injuries, have been in short supply since last year. As a result, hospitals and surgery centers have scrambled to find alternative medications or doses to keep their patients out of pain, raising the risk of potentially deadly mistakes. In at least a few instances, patients have already received potentially harmful doses.

“Just about every hospital in California is dealing with the shortage. … We’re trying to be as proactive as possible,” said Dr. Shalini Shah, head of pain medicine at UC-Irvine Health, who appeared Monday on Southern California Public Radio’s “AirTalk” show, hosted by Larry Mantle.

Shah said her health system has found ways to meet patient needs, such as giving tablet forms of the opioids to those who can swallow, using local anesthetics like nerve blocks and substituting opiates with acetaminophen, ketamine and muscle relaxants.

Donald Kaplan, a pharmacy director with Kaiser Permanente in Southern California, said the health system has been able to “make do,” in part because it has national purchasing contracts with multiple drugmakers. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

But Kaiser’s pharmacy directors must have weekly calls to manage the shortage, and are coordinating drug shipments to hospitals with scant supplies “sometimes several times per week,” said Kaplan, who joined Shah on the air.

Supplies of the injectable painkillers have been dwindling since June 2017, when Pfizer, the drugmaker that owns at least 60 percent of the market share of injectable opioids, reduced production while upgrading its Kansas-based factory.

National associations for anesthesiologists, hospitals, oncologists and pharmacists said federal restrictions on opioid production have exacerbated the problem, and the groups have called on the U.S. Drug Enforcement Agency to loosen its manufacturing quotas.

California Healthline Sacramento correspondent Pauline Bartolone joined Shah and Kaplan for the discussion.

Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.

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