The prospect appalls Senate Minority Leader Charles E. Schumer: People – sometimes children – suffering unnecessary pain after surgery or while undergoing cancer treatments, simply because of “bureaucratic finger-pointing and lack of timely and effective action.” He wants the U.S. Drug Enforcement Agency to lift production quotas that may be limiting the supply of legal opioids used nationwide. It is exactly what should happen.
As News Washington bureau chief Jerry Zremski wrote, the situation affects Roswell Park Comprehensive Cancer Center, among others. Candace S. Johnson, chief executive officer, spoke of the cancer patient as collateral damage, adding that the result could be a “national disaster.”
The cause for concern: the shortage of premeasured doses of hydromorphone, morphine and other injection opioids that doctors in hospitals and hospices use to treat pain caused by some cancers and traumatic injuries.
Roughly 80 percent of Roswell Park’s 125 cancer patients rely on opioids to manage intense pain caused by many cancers. Roswell Park pharmacists have been mixing, dividing up and repackaging opioids. It is a costly creative solution: nearing $2.7 million in 18 months.
Erie County Medical Center, the region’s level-one adult trauma center, in addition to “procuring supplies” is also compounding its own drugs, in the same manner as Roswell Park.
Doctors at the Center for Hospice & Palliative Care, which runs Hospice Buffalo, have been in the difficult position of deciding when to use opioids and when second-choice alternatives can be substituted. The shortage of injection opioids and patients who cannot take medicine orally results in some patients getting opioids delivered through the rectum.
Again, as Zremski’s article indicated, this is not just a local problem. Five national medical groups, led by the American Hospital Association, recently wrote to the DEA warning that should the shortage get any worse, medical care will be affected.
The shortage intensified when Pfizer, the main supplier of injection opioids, scaled back production at its plant in McPherson, Kan., last June. It coincided with an upgrade to its facility.
Another blow hit when one of Pfizer’s suppliers of a key component of its pre-filled syringes experienced a quality-control problem and, as a result, Pfizer placed a temporary hold on its shipment of all such products. It created a domino effect, as Pfizer controls the majority of the market for prescription opioids and other producers do not have the capacity to fill the void.
Rep. Brian Higgins, D-Buffalo, who is also leading the way on this issue and has sent a letter to the DEA, its inspector general and the Food and Drug Administration, is absolutely right when he says that there needs to be a balance between controls of supply and legitimate need.
The opioid crisis is real and demands close attention by government regulators. But governments must be careful not to create collateral damage among those suffering intense and chronic pain.