The Hospital Opioid Crisis

The opioid crisis facing the United States has resulted in a number of unintended consequences, including a dangerous shortage of opioid medications at hospitals across the nation. This is surprising for many because in the developed world, countries with a highly developed health care system (which also costs a lot of money), people are used to treatments and medication being available in abundance. Many prescription drugs are hardly ever used, stored in piles in private homes or never used.

Opioid shortages have as a result, prompted doctors, pharmacies and patient advocacy groups scrambling to get critically important medications where they are needed most – to patients who are facing surgery, or those suffering severe pain from traumatic injuries or cancer.

The shortage of injectable opioids such as Fentanyl, Dilaudid, hydromorphone and morphine was triggered, in part, by the US-based Food and Drug Administration (FDA) decision that some manufacturing plants be closed after inspections revealed significant violations.

In addition to manufacturing problems, the DEA (Drug Enforcement Agency), responsible for establishing national quotas for opioid producers, has ordered substantial reductions in 2017, and again in 2018, in an attempt to gain control of the skyrocketing “opioid epidemic”.

As a result, patient comfort, health and safety are compromised when patients receive less effective drugs such as muscle relaxing medication or acetaminophen (Paracetamol), thus rationing the scant supply of painkilling medications for patients with a higher level of pain. In some cases, patients are provided with extremely expensive alternatives.

The shortage of opioid medications is uneven across the US. The supply of in some areas has forced hospitals to postpone elective surgeries such as hernia repair and gallbladder operations.

The opioid shortage has affected not only hospitals, but various healthcare settings such as emergency response providers and ambulatory surgery centers.

Higher Risk of Mistakes

Medication safety experts are concerned that the shortage of opioid drugs – especially prefilled syringes and prepared doses that can be added to intravenous fluids, increases the risk of dangerous errors potentially leading to serious harm or even death.

Calculating the proper dosage isn’t easy, and even a seemingly small mistake can make a tremendous difference in outcomes. However, hospitals are requesting medical staff to use pills instead of injectables whenever possible, which creates a number of problems for patients who are unable to take oral medications.

Several organizations, including the American Society of Anesthesiologists, American Hospital Association, Institute for Safe Medication Practices and American Society of Clinical Oncologists have asked the DEA to mitigate the shortage by adjusting its quota on the manufacture of opioid medications.

Critics of the government’s role in the shortage claim that opioid deaths are the result not a problem of hospitals and medical providers, but of nonmedical use of dangerous drugs. Some cynics say that patients in pain, and the medical providers who are trying to help them, are “collateral damage” in a futile war against the illegal use of opioids, a war which cannot be won.

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