As the pandemic continues to spread across the U.S., orders for medicines needed for Covid-19 patients who are placed on ventilators are being filled and shipped to hospitals only 53% of the time, down from 72% last month, according to new data.

The decline reflects surging demand for more than a dozen sedatives, anesthetics, painkillers, and muscle relaxants, which have been in short supply. The findings raise the possibility that it could become more difficult for health care providers to place these patients on ventilators, because the drugs are used to help manage pain and comfort levels while a patient is on mechanical ventilation.

The overall demand for these drugs rose 87% from January to March alone, but rose a whopping 213% from January to April. Taken together, the data indicates the need for the medicines remains exceedingly strong and shortages are likely to persist.

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“We can’t lose sight that ventilators, and the medications necessary for those patients, is a 1:1 equation,” said Dan Kistner, group senior vice president, pharmacy solutions at Vizient, a group purchasing organization that negotiates contracts for medicines on behalf of about 3,000 hospitals and health care facilities in the U.S., which provided the data. “And demand isn’t going away,” he added.

Demand for sedatives and anesthetics, as well as muscle relaxants all fell 4% during the five-day work week of April 6 to April 10, compared to the week of March 30 to April 3. And demand for painkillers rose 3% during that week.

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Fill rates for sedatives and anesthetics, meanwhile, fell from 52% to 49% during that same week. It also dropped for muscle relaxants, from 50% to 43%. For painkillers, the fill rate remained flat at 69%. The comparisons did not include weekends because fewer orders and deliveries occur then, Kistner noted.

Most of the medicines that the company tracks are listed as experiencing shortages by the American Society of Health-System Pharmacists, which regularly compiles information on drugs that are in short supply among hospitals across the U.S. The reasons for the shortages are not always disclosed and updates vary, but in many cases, the ASHP cites manufacturing problems or increased demand.

Last week, the U.S. Drug Enforcement Administration took steps to permit increased production and importation of several of these medicines. The agency is increasing production quotas by 15% for several controlled substances, including fentanyl, morphine, hydromorphone, codeine, ephedrine, and pseudoephedrine, as well as certain so-called intermediates that are essential to producing these medicines. The DEA also plans to approve increased imports of ketamine, diazepam, midazolam, lorazepam, and phenobarbital.

There may be another way to hasten production, though, and mitigate the effect of any shortages.

Injectable medicines typically need at least 21 days in quarantine after being manufactured, but the Food and Drug Administration could ease certain requirements for sterility testing on a case-by-case basis to allow for faster release to the market, as long as strict process controls are in place, according to the U.S. Pharmacopeia, an independent organization that publishes standards for manufacturing medicines.

This post was updated to clarify that many hospital orders – not retail prescriptions – are going unfilled. 

  • Hey Ed,
    Who fills prescriptions for medications used in the ICU? Answer is: nobody. I think the Vizient data shows that only a fraction of the orders hospital pharmacies are placing for these drugs are getting filled by the wholesalers. No prescriptions involved in these transactions. Let me know if you need any help understanding hospital pharmacy.

    • Hi Eric,

      Thanks for your note, as well.

      And I also appreciate your attention to detail. I do think it should be obvious that the medicines being discussed here are being administered by hospital physicians for patients on ventilators – in the facilities – and are not prescriptions that are being picked up by patients at a retail pharmacy, whether located in a hospital or elsewhere.

      That said, I have changed the word ‘prescriptions’ to ‘orders,’ to make it all as clear as possible.

      Hope this helps,
      ed at pharmalot

  • There is a distinct and extremely important difference between 53% of prescriptions being filled and 53% of orders being fulfilled by wholesalers.
    While we are struggling with supplies and working diligently to care for all patients, we are filling 100% of prescriptions. This article is misleading and should be corrected immediately.

    • Hi KM,

      Thanks for the note.

      And I appreciate your attention to detail. I do think it should be obvious that the medicines being discussed here are being administered by hospital physicians for patients on ventilators, and are not prescriptions that are being picked up by patients at a retail pharmacy, whether located in a hospital or elsewhere.

      That said, I have changed the word ‘prescriptions’ to ‘orders,’ to make it all as clear as possible.

      Hope this helps,
      ed at pharmalot

  • Ed:

    We in US have a serious supply chain problem. The current crisis is tip of the iceberg. Does US have stock pile of essential drugs? Has any one checked?

    World got caught with no pants on COVID-19 and US is scrambling to find treatment, ventilators and PPE.

    Are we ready for the next pandemic?

    Let’s assume three common class of drugs [metformin hydrochloride, ciprofloxacin and any NSAID] are needed for the next pandemic. World does not have manufacturing capacity or the reserves for either of these to fulfill the needs of 10% of the 7.4 BILLION on a sustained basis for ONE year. We don’t have necessary raw materials that can allow production for e.g. six months on a sustained basis. National Stockpile does not have drugs that will last.

    Currently used technologies are old and bench top technologies. My point “ARE WE READY FOR THE NEXT PANDEMIC WHERE e.g. CURRENT COMMON DRUGS WOULD BE NEEDED?” Most likely NO. Global supply chain is in shambles.

    Shouldn’t we be thinking. I hope SOME SAGE WITH LONG WHITE BEARD SITTING ON A MOUNTAIN TOP IS.

    IS US or the WORLD ready for its next challenge or are we going to blame others for our incompetencies? What are your thoughts or is anyone thinking?

    Be safe and well.

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