Local healthcare providers have been struggling to supply patients with injectable morphine, according to representatives from St. Joseph, Mad River and Jerold Phelps hospitals.
“This is a very multi-faceted topic, not limited to opiates alone,” Terry Lerma, director of pharmacy services at St. Joseph Hospital told the Journal
. “Most of the nation has been grappling with a series of critical medications shortages for two years.”
National news coverage of the issue cites an unfortunate confluence of several factors, including natural disasters that have slowed manufacture of some products and stronger restrictions on opiate production in response to a nationwide addiction crisis. Lerma said that all of these factors, as well as a shortage of the raw materials necessary to create the medication – specifically raw opium produced in Afghanistan and Pakistan – have impacted hospital pharmacies.
“Hurricanes and flooding, other natural disasters have wiped out major pharmaceutical manufacturers,” Lerma said, referring to September’s Hurricane Maria, which according to an article in The Guardian
, wiped out a large IV fluid manufacturer in Puerto Rico.
As a result, Lerma said his team has had to become more “nimble” in how they respond to patient need. The Journal
was tipped off to the shortage by the loved one of a hospice patient, for example, who was receiving palliative pain care through the administration of oral morphine, with drops placed under the tongue, rather than through an I.V. drip.
“We communicate daily with service providers,” Lerma said, explaining that, depending on what is and is not available, what is prescribed may shift from patient to patient, from day to day. “We knock on every door. Maybe we have a surplus of hydromorphone, and we may have to shift prescribing towards Fentanyl.”
Tina Wood, critical care manager at Mad River Community Hospital, said the shortage has affected emergency medical services, specifically the two ground ambulances for which the hospital is a base station.
“If we have no morphine, we have none to supply our EMS partners and they have none for those patients who truly need some analgesia related to traumatic injury or severe medical conditions,” Wood explained to the Journal
via email. “Some of our folks that come in by ambulance have a more than 90 minute ride to get to our facility. That is a long time to be bouncing along and in pain.”
Wood said the irony was not lost on her that after decades of medical facilities being accused of undertreating pain, the crisis has come full circle: “We have caused addiction by over-treating pain. We have the crisis in the face of nationwide shortages of analgesic medications. ... The irony is not lost on myself or my staff."
Synthetic analgesics, the alternatives such as Fentanyl and Demerol that Lerma referred to, have some shortcomings compared to Morphine Sulfate, which is derived from opium poppies, Wood said. Fentanyl wears off quickly; Demerol should not be given to older folks.
“(Mad River Community Hospital) has a long standing practice of limiting the administration of opioids unless necessary,” Wood wrote in her email, describing the progressive process nurses and doctors usually take to make patients comfortable, beginning with heat or cold, then non-opiates before progressing to “very small doses of opioids.”
“The nationwide shortage of morphine is affecting us, both in-house and (emergency medical services),” Wood said. “I do not anticipate that it will resolve anytime soon. We are getting creative in our approach."