Drug Shortages

Once again, community pharmacy staffs across the country are taking abuse for not having drugs in stock. Once again, this is not our fault. I made a tablet in a History of Pharmacy wet lab. Notice the word “history” that sentence. While I can throw together a cream, ointment, emulsion, suppository, or a capsule with the best of them, we don’t make tablets anymore. Manufacturers manufacture, dispensers dispense, and we like it that way—provided the drugs are coming in. I don’t know what the problem is, but they haven’t been.

If you want to have a bad day, try telling a professional narcotic ingester with a case of the fits that we don’t have the 30 mg oxycodone tablets that make up his outrageous 180 mg total daily dose, and we can’t substitute with other strengths because, a) It’s a narcotic, and it’s against the law to do that, and b) Even if your doctors agree to issue another script, we don’t have those strengths either. I never get accused of having the drug and not wanting to fill the prescription because I think the patient is an addict. I never have my parentage questioned by said patient. Never happens.

It’s not just opiates either. We went about 4 months without a single brand or generic Ritalin tablet, and only recently has the drug started to trickle in, with the 20 mg immediate-release formulation still nowhere to be found. Sustained-release metoprolol succinate (Toprol XL) is one of the most popular hypertension medications in my pharmacy. I imagine it does well across the country. With a decent side-effect profile and mainly once-a-day dosing, I think it’s a fantastic drug. We went about 4 months without a single tablet of any strength and had to scramble to convert a bevy of patients to other medications, risking new side effects and compromising patient care.

I don’t claim to know a thing about raw material shortages or maintaining a supply chain, but I was 6 years old once and remember School House Rock’s lesson on supply and demand. In various strengths, my pharmacy dispenses thousands of tablets of the drugs I mentioned per week, and when we don’t have them, it makes life ... difficult. It seems to me that even if the drug is a regional favorite, that it should be profitable enough to keep a ready supply on hand. I would like to be shown the pharmacy that does not dispense oxycodone or extended-release metoprolol succinate—based medications on a nearly daily basis.

I believe I speak for all dispensing pharmacists when I say that all we want is for drugs that are well used to continue to come in on the truck and have a ready supply on our shelves so we can take care of our patients. I don’t think that’s asking too much. Peace.

Jay Sochoka, BSPharm, RPh, CIP, dreams of a utopia where partial fills don’t exist, and tablets never go out of stock. He is the author of Fatman in Recovery: Tales from the Brink of Obesity.