Hospitals are facing yet another new obstacle in the fight against the coronavirus: They are running low on the drugs needed to put patients on ventilators to keep them alive.
While much attention has been placed on the desperate hunt for more ventilators, the machines are useless unless they are accompanied by drugs to sedate patients and eliminate pain.
Now hospitals, particularly in hard-hit areas such as New York, say those drugs are getting scarce, along with the ventilators themselves.
“In hot spots, especially New York City, they are running dangerously low on some of these drugs,” said Michael Ganio, a senior director at the American Society of Health-System Pharmacists.
Kenneth Raske, president of The Greater New York Hospital Association, wrote to FEMA on Saturday urging the “immediate release” of any supplies of the needed drugs that are in the Strategic National Stockpile.
“Hospitals in New York and Northern New Jersey are rapidly exhausting all available supply of critical medications,” he wrote.
“We greatly appreciate the release of ventilators necessary to keep patients alive,” he added in the letter. “However, these ventilators will be rendered useless without an adequate supply of the medications.”
Those medications include opioids to kill pain, sedatives and paralytics.
Demand for sedatives such as propofol and midazolam increased by 75 percent in March as the coronavirus crisis worsened, according to data from Vizient, a group-purchasing organization that negotiates drug prices for hospitals. At the beginning of March, about 100 percent of hospitals’ orders for these drugs were filled, but that rate fell to as low as 48 percent by the end of the month.
There were similar spikes in demand for opioids and paralytics.
Adding to the complications, the needed opioids, such as fentanyl and morphine, face production limits from the Drug Enforcement Administration (DEA), given the long-running crisis of opioid abuse.
A coalition of groups, including the American Hospital Association and American Society of Health-System Pharmacists (ASHP), wrote to the DEA asking it to increase production quotas on these drugs last week.
On Tuesday, the DEA announced it would increase the production limits on opioids including fentanyl and morphine by 15 percent to help address the potential shortages.
“DEA is committed to ensuring an adequate and uninterrupted supply of critical medications during this public health emergency,” acting Administrator Uttam Dhillon said in a statement. “This will ensure that manufacturers can increase production of these important drugs, should the need arise.”
The coronavirus crisis is increasing demand for the drugs since patients are staying on ventilators for extended periods of time.
Lee Fleisher, chairman of the Department of Anesthesiology and Critical Care at the University of Pennsylvania Health System, said the problem is both, “we’ve never had so many patients on these ventilators,” and “we’re seeing people on ventilators from anywhere to a week to 16 days.”
As patients are on the machines longer, they can develop tolerance to the drugs, requiring higher doses, he said.
“You don’t want them awake and you don’t want them fighting the ventilator,” he said.
Ganio, of the pharmacists group ASHP, said that in some cases hospitals are being forced to spend time gathering up a large enough dose of a drug by combining smaller vials, because larger doses are not available.
He said the process is akin to an “industrial baker trying to make a week’s supply of bread using 1-pound bags of flour.”
Rep. Mark Pocan (D-Wis.) wrote to Commissioner of Food and Drugs Stephen Hahn on Tuesday expressing “great concern” with potential shortages of drugs needed to put patients on ventilators and asking for information about the administration’s response.
ASHP CEO Paul Abramowitz sent a letter last week to Vice President Pence, who is leading the administration’s coronavirus response. Abramowitz called on him to find ways to get manufacturers to make more of the needed drugs.
“Failure to treat these drugs as anything other than absolutely essential will render ventilators worthless and exact a heavy patient toll,” he wrote.