How Mass General is dealing with the worst opioid shortage in years: 7 things to know

Boston-based Massachusetts General Hospital is one of many hospitals nationwide grappling with a severe shortage of intravenous opioids.

Here are seven things to know about the ongoing shortage and MGH's actions to mitigate its effects.

1. The shortage first sprouted up in June 2017 when Pfizer — which accounts for 60 percent of the United States' injectable opioid market — halted production of several pain medications due to manufacturing issues at a plant in Kansas. These manufacturing issues have left hospitals, hospice providers and other healthcare entities scrambling to replenish supplies of common painkillers used to treat a plethora of patients.

2. John Marshall, PharmD, director of clinical pharmacy services at MGH, said the hospital experienced intermittent supply problems last summer before the shortages worsened in January and hit a crescendo in March.

"In my 20 years practicing pharmacy, this is the worst shortage I have seen," he told Becker's Hospital Review during a May 23 phone interview. "These drugs are fundamentally necessary for the operation of a hospital. When you potentially take their availability away, it can change the way we care for patients."

3. Large academic medical centers like MGH often act as a canary in a coal mine when it comes to national drug shortages, since they treat a higher-volume and sicker patient population and are thus more susceptible to shortages, according to Dr. Marshall.

4. He said MGH has a three- to four-week supply of intravenous opioids on hand. The hospital receives supply shipments once a week, but nothing is guaranteed.

"We don't know what we'll get in or how much quantity," Dr. Marshall said, adding that Pfizer does not expect to return to normal production levels until the first or second quarter of 2019.

5. To mitigate the shortage, MGH's pharmacy team first transitioned appropriate patients to alternative pain management treatments, including oral opioids, multimodal analgesia, and acetaminophen or ibuprofen.

6. Dr. Marshall said shortage warnings, which the pharmacy team had been sending out for months, started to become "white noise" to many hospital leaders. After the hospital's opioid supply experienced a significant drop-off in March, the hospital activated an internal disaster system to ensure all hospital stakeholders understood the severity of the situation.

7. While Dr. Marshall said some of the hospital's mitigation efforts have taken hold, he still monitors opioid levels daily and meets with a multidisciplinary group of nurses, physicians and pharmacists once a week to assess the situation. The hospital is also actively monitoring the safety of these alternative pain therapies, as such sudden changes in medication regimens can sometimes increase the chance for errors.

"The silver lining is [the shortage] has made us be very thoughtful about how we give these medications," he said. "I think some of the practice changes, such as using a lot of nonopioids, will certainly endure even after the shortage is gone."

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