The long lasting drug shortage

Get ready, not afraid !

As I wrote a few days ago on Twitter that I would make a not-too-extensive Substack piece about this matter, so here we are.

First, a smaller one but given the overprescription of this drug, and how it causes literal crashes and has a tendency at medium to long-term to make users borderline non-functional. Adderall.

Later last month 4 companies responsible for 50% of the extended release of Adderall were having supply problems and shortages were hitting different places in the US.

Few days ago two more suppliers now find themselves with problems, ending with a total of seven pharmaceutical companies, disrupting the availability of both immediate and extended-release.

With just-in-time ordering, the health system relies on distributors to deliver supplies quickly rather than hospitals keeping them in stock. “Many of those things on a daily basis don’t show up,” Lee says. She’s resorted to having her team of doctors and nurses search for substitutes, which requires training nurses in the slight differences in how they might operate. “This is not really like Coke and Pepsi,” Lee says. “It’s a massive, massive effort every day that we’re really struggling with.”

Owens & Minor, a healthcare logistics firm with $8.5 billion in annual revenue, says that 45% of the items it handles are in some way supply-constrained. They include hypodermic needles and flush syringes, blood-collection tubes, surgical tape, surgical gloves, suction canisters, IV solutions, dialysis concentrates, a variety of wound-care products, sharps containers, catheters and adult and pediatric nutritional products.

Medline, another large medical supply company, says that hospitals, surgery centers, nursing homes and healthcare providers are all feeling the crunch. “Due to industry-wide supply disruptions, stockpiling has become essential for healthcare resilience,”

(it is ironic they mention Coke, because I have gone through 3 shortages of Coke Zero around here… lol)

One shortage always feeds the other, and on a larger scale, the problems with energy and byproducts of petroleum will affect every other product on the planet by cascade effect alone. The shortage of plastic has been going on for a while now, and it has been disrupting healthcare since early 2021. Syringes, blisters for pills, and everything in between are in literal short supply.

The FDA has a list of Medical Devices is shortage, and as you can see for yourself it is quite extensive, and so it is the drug shortage. To this day we are still living through the ripple effects of the start of the pandemic in 2020, its measures, and the cost of applying such stupidity at a global scale.

China is the biggest producer of APIs in the world (Active Pharmaceutical Ingredients), and any time a disruption hits their producing regions, it affects India (one of the biggest producers of drugs in the world, and their import 60% of their APIs from China). Under any type of supply constraint or disruptive events, countries will resort to halting exports, as India did earlier in 2020.

Recently one of Teva’s manufacturing facilities faced trouble from the FDA over the fears of contamination, and they decided to close the factory, creating a bigger shortage of blood pressure medications, and chemo.

An FDA inspection in July last year found the company hadn't repaired water damage at the site and failed to maintain procedures to keep factory workers from spreading mold and bacteria. The regulatory agency also said Teva failed to make sure equipment it installed more than two decades ago to test for sterility and harmful organisms worked properly.

Operating at capacity, with low to no maintenance, untrained or overworked labor, plus corporate greed to save a buck will often lead to such events, where accidents like this are overlooked and lead to massive disruption in supply shortages, this is a superficial point. The real point is, contamination can create seismic changes that other manufacturers can’t allocate.

Part of the baby formula shortage was contamination. You would not believe how easy it is for someone willing enough or a state actor to culture and contaminate the production of anything with bacteria, with some thinking outside the box. Why I am writing all of this and making these points ?

I could elongate myself to further make my point, but so far I think this is enough, given everything I covered and wrote in Beyond Mathematical Odds, all the currents events taking place, you should seriously consider building a little stock of drugs you use/need or drugs that can become harder to find.

We will enter a very uncertain period at least for a few months, energy insecurity and high prices fueled by inflation will dictate many of the events unfolding in the next months, and I do not see how the drug shortage gets any easier or better short-term. In the occasion of unforeseen events taking place and disrupting global trade even further, or affecting the production of said materials and ingredients, or for some reason vast swaths of people get sick with a myriad of diseases and overwhelm hospitals, the shortages would intensify and get at critical levels.

If I am completely off and wrong, you save money because of inflation and current trends, if I am right at any level, well, you are rather prepared. I have been meaning to bring this to the attention of my readers for a while.

My next SARS-CoV-2 piece might come out tomorrow or Saturday, just an FYI.

Big thank you to all supporters here and in Kofi and everyone who shares the Substack.