Drug shortages: The new reality for veterinarians
According to the New York Times, Obama’s order will instruct the Food and Drug Administration to do three things: broaden reporting of potential shortages of certain prescription drugs; speed reviews of applications to begin or alter production of these drugs; and provide more information to the Justice Department about possible instances of collusion or price gouging.
For veterinarians, however, prescription drug shortages have been a growing problem over the years that is not likely to go away any time soon.
A growing issue
Margo Karriker, clinical pharmacy specialist at the University of California Davis, says drug shortages are becoming more and more common for veterinarians.
"Every single day we’re seeing something that we use becoming unavailable," Karriker says. "A lot of it is around the fact that so many of the drugs we use are human-labeled drugs."
Karriker says veterinarians are experiencing the same drug shortages that human doctors are, and that a lot of the shortages are occurring because so many of the drugs veterinarians use are human-labeled drugs that are also in short supply. The trickle-down from the human-labeled products then affects veterinarians who use the same human-labeled drugs in animals.
Two big medications in short supply are oncology drugs for cancer patients and anesthetics for patients undergoing surgeries.
Karriker says anesthetic shortages started last year with an initial recall on propofol. The shortage then spread to other anesthetics.
Other shortages include drugs like amikacin, an antibiotic used to treat different types of bacterial infections. Veterinarians initially had supply for amakacin when human doctors were in short supply of the drug. However, drug companies said that due to supply and demand, the short supply would spread to the veterinary-labeled product as well.
"It seems to be an issue that is growing and growing. It’s a snowball effect," Karriker says. "For us, we felt the impact more in 2011 than ever previously. Every time we turn around, it seems that there is another drug shortage."
Small animal veterinarians are not the only ones suffering from the drug shortages. Karriker says every veterinarian in the industry is being impacted by the shortages.
"All veterinarians are impacted somewhat," Karriker says. "The scenario that made the short supply come into effect affects all veterinarians, large animal veterinarians, exotics, everyone. I’m glad it’s gaining the importance that it is."
The next best option
When a primary drug becomes unavailable, veterinarians must turn to secondary options that are less than appealing.
"When our primary drug of choice is gone, we have to choose from a second or third option," Karriker says. "In some cases we have to determine the next best therapeutic option. Sometimes, this can be a problem because the substitution of products can be wrong due to dosing errors."
Karriker says studies have shown that substitution products can often have detrimental effects that occur due to a lack of staff knowledge of and experience with the drugs.
Often, veterinarians have to offer combination drug therapies when a single drug is unavailable. For clients, however, this can be a more expensive approach to caring for their pet; it is also more difficult for clients to administer two drugs instead of just one.
Karriker says that though the cost of drugs on the human side can often be offset by third parties, the cost of drugs or medical care for animals goes directly to the pet owner pocketbooks.
Oftentimes, the cost of care may not be something the client can afford.
"If the cost of care or a surgical procedure in the next best option is too high, sometimes putting a patient down is the only choice clients have," Karriker says.
A bleak future
Production issues and large scale recalls with minimal explanations from drug companies are impacting the entire medical community, not just veterinarians and human doctors. President Obama’s efforts to improve the situation are a step in the right direction, but the movement to end drug shortages shouldn’t stop there, Karriker says.
"We feel this is of national importance - it impacts health care in general. The biggest concern is for us to get the drugs we want back on the shelves for our clients at an affordable cost," Karriker says. "I am very anxious to see how this will play out. It would be nice to see an immediate answer by the FDA as to the logistics and nuts and bolts of this."
Karriker says one important step is to increase the number of available drugs on the market so that veterinarians have more options to choose from.
"We really need to get more drugs approved," Karriker says. "If we had plenty of options available, one or two drug shortages wouldn’t be that big of an impasse."
Drug companies also need to be more transparent, Karriker says. Increasing transparency will help lead to more accountability.
"Drug companies don’t always have to disclose why the shortages occur," Karriker says. "We need more transparency in that process so that the companies are more accountable. To date, generic producers are not required to be transparent, and companies aren’t seemingly as accountable to the FDA as we would like them to be."
However, Karriker says that even with very aggressive legislation that may address one concern, there are still many other factors that will continue contributing to drug shortages.
"I think [Obama’s announcement] is a big move. I think it should have an impact on us, but my feeling is that it’s not going to be very immediate - we know this is not going to be rapidly addressed," Karriker says. "This might just be the new reality."