title: Drug shortages: Implications for medical toxicology.
abstract: BACKGROUND
  Drug shortages have significantly increased over the past decade. There are limited data describing how shortages impact medical toxicology of drugs.
  
  
  OBJECTIVE
  To characterize drug shortages affecting the management of poisoned patients.
  
  
  METHODS
  Drug shortage data from January 2001 to December 2013 were obtained from the University of Utah Drug Information Service. Shortage data for agents used to treat poisonings were analyzed. Information on drug type, formulation, reason for shortage, shortage duration, marketing, and whether the drug was available from a single source was collected. The availability of a substitute therapy and whether substitutes were in shortage during the study period were also investigated.
  
  
  RESULTS
  Of 1,751 shortages, 141 (8.1%) impacted drugs used to treat poisoned patients, and as of December 2013, 21 (14.9%) remained unresolved. New toxicology shortages increased steadily from the mid-2000s, reaching a high of 26 in 2011. Median shortage duration was 164 days (interquartile range: 76-434). Generic drugs were involved in 85.1% of shortages and 41.1% were single-source products. Parenteral formulations were often involved in shortages (89.4%). The most common medications in shortage were sedative/hypnotics (15.6%). An alternative agent was available for 121 (85.8%) drugs; however, 88 (72.7%) alternatives were also affected by shortages at some point during the study period. When present, the most common reasons reported were manufacturing delays (22.0%) and supply/demand issues (17.0%). Shortage reason was not reported for 48.2% of drugs.
  
  
  CONCLUSIONS
  Toxicology drug shortages are becoming increasingly prevalent, which can result in both suboptimal treatment and medication errors from using less familiar alternatives.
  
  
  CONCLUSIONS
  Drug shortages affected a substantial number of critical agents used in the management of poisoned patients. Shortages were often of long duration and for drugs without alternatives. Providers caring for poisoned patients should be aware of current shortages and implement mitigation strategies to safeguard patient care.
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center , Washington, DC , USA.
authors.forename: Maryann
authors.initials: M
authors.lastname: Mazer-Amirshahi
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Hawley
authors.forename: Mark
authors.initials: M
authors.lastname: Zocchi
authors.forename: Erin
authors.initials: E
authors.lastname: Fox
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
mesh_terms: D000931:Antidotes / Q000600:supply & distribution*; D003695:Delivery of Health Care; D004345:Drug Industry / Q000458:organization & administration; D004346:Drug Information Services; D057915:Drug Substitution; D016568:Drugs, Generic / Q000600:supply & distribution*; D006801:Humans; D008508:Medication Errors; D061214:Patient Safety; D011041:Poisoning / Q000188:drug therapy*; D055553:Prescription Drugs / Q000600:supply & distribution*; D013997:Time Factors; D014116:Toxicology; D014589:Utah
chemical_list: D000931:Antidotes; D016568:Drugs, Generic; D055553:Prescription Drugs
keywords: Antidotes; Drug shortages; Medical toxicology