By Michael DePeau-Wilson

Medications critical for treating patients with COVID-19, such as propofol, morphine and epinephrine, are in short supply, prompting recommendations for stricter measures to reduce medication waste from the American Society of Anesthesiologists (ASA) and the American Society of Health-System Pharmacists (ASHP).

Other drugs that are currently in shortage include dexmedetomidine, atropine, fentanyl, ketamine, hydromorphone, cisatracurium, dopamine and dobutamine. These drugs are included on the FDA and ASHP lists of drug shortages because of problems with formulations and manufacturing capability, which does not necessarily mean there is no supply available. 

The ASA and ASHP recommendations focus on several practices for minimizing wastage of these medications, including protecting drugs from contamination, following guidelines for extended expiration dates and compounding drugs, when possible. The measures listed in the joint statement focus on medications required for intubation and mechanical ventilation of COVID-19 patients.

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Drug shortages have been an ongoing concern for several years, but the current shortages present new challenges for providers and health systems.

“The cause of drug shortages that have arisen during the COVID-19 pandemic are not the usual, chronic shortage issues,” said Beverly Philip, MD, the president-elect of the ASA. “During the COVID-19 pandemic, drug shortages have been caused by increased demand of additional drugs for ICU care needed to treat the large increase in ICU patients.”

Dr. Philip, who is also the director of ambulatory anesthesia at Brigham and Women’s Hospital and a professor of anesthesia and pain management at Harvard Medical School, in Boston, has led the ASA’s efforts to address drug shortages since long before the COVID-19?related supply concerns. She said the current shortages for ICU patients mean providers are turning to secondary options for treating these patients.

Switching from first- to second-choice therapies is not the only concern addressed in the new recommendations. The cumulative effect of the shortages has the potential to delay care to patients waiting for elective surgeries, according to Dr. Philip.

“A critical part of this road map is evaluating patients beforehand to be sure there have been no health changes, particularly due to known or unknown pandemic disease, so patients can have surgery safely,” Dr. Philip said. “Most of these procedures will require anesthesia care. The drugs usually used to provide anesthesia overlap with [these] drugs needed for intensive care.”

Although no delays have been reported due to drug shortages, concerns about worsening shortages have led to recommendations for preserving and extending the life of these medications.

Those recommendations tie closely to the ASA’s road map for safely resuming elective surgery after COVID-19 cases begin to decline, which could be vulnerable to increases in shortages of drugs critical for the care of both patients with COVID-19 and those awaiting elective surgery.