Dr. John Berger, a Hillcrest family medicine practitioner, wanted to inject cortisone into his patient’s knee this week, but ended up aborting the procedure when his office staff informed him that his supply of lidocaine had run out.
Without the local anesthetic, there was just one option.
“I couldn’t do it, because it would have been way too painful,” Berger said. “I had to send her on her way.”
Eventually, he said, he was able to locate the doses he needed, but only at five times the usual price.
Such is the nature of an ongoing lidocaine shortage, one of 106 current drug shortages listed by the U.S. Food and Drug Administration. Drug shortages, especially those associated with injection opioid painkillers, have been a continuous problem for medical providers at all levels this year.
A survey of San Diego County health providers found that, in general, the lidocaine shortage seems to be hitting independent practitioners in primary care the hardest. The largest systems seem to be doing better and stockpiling supply.
Kaiser San Diego, for example, reported having a four- to 10-week supply of the drug on hand, depending on dosage strength. Neither Kaiser, Scripps Health nor Palomar Health reported any procedure cancellations due to shortages of the drug also known as Xylocaine.
But that doesn’t mean that Berger’s experience was necessarily an outlier.
Virginia Herold, executive officer of the California State Board of Pharmacy, said Tuesday that she is aware of hospitals postponing surgeries due to drug shortages in California, including lidocaine.
“Drug shortages are impacting patient health,” Herold said.
Zeroing in on lidocaine in particular, it’s not clear exactly what is driving the current shortage. In the FDA’s online database of shortage notices, one manufacturer lists “manufacturing interruptions and demand increase” as the main reasons why it has not been able to meet demand while another stopped making the drug and a third says its supply is backordered due to a “manufacturing delay.”
And, supply from a key compounding pharmacy, a company that mixes IV bags, pre-loaded syringes and other products, came under heavy scrutiny earlier this year for substandard manufacturing practices. On Feb. 27, the state board of pharmacy issued a cease-and-desist order to PharMEDium Services, citing 14 different quality-control issues and baring the company from shipping its products into California. In December 2017, the FDA issued an inspection report which took exception with some manufacturing practices at the company’s plant in Memphis.
Are these issues contributing to lidocaine shortages in California? Maybe, but that’s not the whole story, Herold said. Hurricaine damage in Puerto Rico, where many drugs are manufactured, is likely another part of the puzzle. Doctors are also more often using lidocaine instead of opioids when treating pain in hospitals. Hospitals, Herold added added, also tend to have full-time dedicated purchasing managers able to spot coming shortages early and stockpile the drugs they need.
“Hospitals work very hard to make sure they don’t run out,” Herold said.
Dr. Ted Mazer, a San Diego ear, nose and throat specialist and president of the California Medical Association, said he, like Herold, suspects that shortages are being felt more directly in doctor’s offices than in emergency departments or surgical suites.
“They have prioritized supply to larger providers,” Mazer said. “At the medical society, the lidocaine issue has not itself been the main issue, but we are constantly fielding calls from doctors on other medication shortages, especially for some opioids.”
Mazer said that the growing number of drug shortages often defies easy explanation. He said it is incumbent upon the FDA to get to the root of these shortages and find a way to make the supply of bedrock medical staples like lidocaine more reliable.
“It is reasonable to ask the FDA to step in and investigate the constant shortages of staple medications and determine how much of this is preventable,” Mazer said.
Toward that end, the FDA recently announced a new Drug Shortages Task Force which, according to a statement from the agency, will “delve more deeply into the reasons why some shortages remain a persistent challenge.”
“Our mission is to ensure that patients have access to the drugs they need. The task force will report regularly on its progress,” the FDA’s statement said.
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paul.sisson@sduniontribune.com
(619) 293-1850
Twitter: @paulsisson
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