Hospital opioid shortage could leave terminal patients in pain, cancer physician says

As physicians and policymakers search for ways to deal with excess pills fueling the opioid epidemic, cancer physicians fear potential shortages in injectable opioids needed to treat critically ill patients, Tara Soumerai, MD and oncologist at Boston-based Massachusetts General Hospital, argues in a STAT op-ed.

Here are five insights from the op-ed.

1. Dr. Soumerai recalled a patient dying of lung cancer who was experiencing air hunger, which occurs when patients with rapidly growing lung cancer feel unable to get enough air. 

"His air hunger was something we could definitely ease. Opioids are excellent at doing that," Dr. Soumerai wrote. "Finding the right oral dose can take hours, even days. [The patient] needed help right away, so an intravenous opioid was our only option."

After the patient began an infusion of an opioid, he was able to breathe easier and decrease his pain. The patient died about 36 hours later with his family at his bedside. "My team's ability to administer an intravenous opioid at an escalating dose allowed [the patient] to have a peaceful final few hours with his family," Dr. Soumerai added.

2. "Until recently, I took for granted my ability to use this essential medication," Dr. Soumerai wrote. "Now I worry every day that I won't be able to provide it to my patients." Although Drug Enforcement Administration policies to curb the opioid crisis are well-intended, decisions to cut opioid production by 25 percent in 2016 and an additional 20 percent in 2017 have threatened opioid availability for terminally ill cancer patients, Dr. Soumerai wrote.

3. Pharmaceutical giant Pfizer's acquisition of drugmaker Hospira has worsened this problem, Dr. Soumerai noted. "The move means that 60 percent of our country's intravenous opioids are being made by a single pharmaceutical company."

After a Hospira plant that produced most of America's prefilled opioid syringes had to halt production last year, Pfizer experienced a significant manufacturing setback that resulted in ongoing production shortages.

4. The shortage is expected to last for the next 12 to 18 months, Dr. Soumerai noted. "Our hospital's current supply of intravenous opioids will last about four weeks at best," she wrote. "Seasoned pharmacists at my hospital, who have seen many drug shortages over their careers, have told me this is the worst one they have seen in more than a decade."

5. "There's no question that decades of unchecked opioid production, marketing, and prescribing led us to where we are today, with more than 40,000 deaths from opioid overdoses a year. We clearly need to target that abuse," Dr. Soumerai wrote. "It's equally important that federal and state efforts to rein in opioid abuse don't force people who need these medications to suffer for a single day without them," she added.

"Acceptable quality of life for terminally ill patients admitted to hospitals can't be sacrificed in the rush to control a different public health emergency."

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