Medication Shortages: How to Manage When Drugs Aren’t Available

When your hospital runs out of morphine, or the IV antibiotics your patient needs don’t arrive, you don’t get a warning. You just wake up to a broken system. Medication shortages aren’t rare glitches-they’re a daily reality in hospitals across the U.S., and increasingly in places like New Zealand, Canada, and Australia too. In 2022, the FDA recorded 287 drug shortages, affecting nearly one in five essential medications used in hospitals. And it’s not just about running out of pills. It’s about delayed surgeries, increased errors, and patients getting sicker because the right drug isn’t there when they need it.

What’s Really Causing These Shortages?

The biggest culprit? Manufacturing problems. In 2022, 46% of all drug shortages were caused by quality failures in production facilities-contaminated batches, unclean equipment, or failed inspections. Most of these are generic sterile injectables: the drugs you rely on during emergencies-morphine, saline, antibiotics, cancer treatments, and IV nutrition. These aren’t fancy brand-name pills. They’re cheap, high-volume drugs made by just a few factories. And here’s the problem: three companies control 75% of the U.S. supply for these critical injectables. If one plant shuts down for cleaning or fails an FDA audit, the whole country feels it.

Why does this keep happening? Because there’s little financial incentive to fix it. Generic drug makers operate on razor-thin margins. When the government forces them to sell drugs at rock-bottom prices through Medicaid and 340B programs, they can’t afford to invest in better equipment, redundant systems, or quality controls. A 2023 HHS report found that these reimbursement rules actively discourage manufacturers from improving reliability. Meanwhile, 80% of the raw ingredients (APIs) for U.S. drugs come from overseas-mostly China and India. A single flood, political disruption, or export ban can ripple through the entire supply chain.

Who Gets Hit the Hardest?

It’s not evenly distributed. Rural hospitals, safety-net clinics, and facilities serving Medicaid or uninsured patients are hit hardest. A 2023 American College of Physicians study found that 78% of these hospitals had to cancel or delay procedures because of drug shortages. In urban centers, pharmacies might scramble to find a substitute. In small towns, there’s often no backup at all. Patients with cancer, chronic pain, or heart failure are the most vulnerable. One oncology nurse in Ohio told me her team had to delay chemotherapy for three weeks because the only available alternative wasn’t FDA-approved for that use. That’s not a choice-it’s a compromise forced by systemic failure.

Even when alternatives exist, they’re not always safe. When morphine ran out, many hospitals switched to hydromorphone. Sounds similar, right? But hydromorphone is five to seven times more potent. A 2023 Reddit thread from a hospital pharmacist described a spike in medication errors-15% more mistakes during the transition. Nurses weren’t trained on the new dosing. Charts weren’t updated. Patients got too much. Or too little. And nobody had time to fix it because everyone was working 12 extra hours a week just to keep up.

How Hospitals Are Trying to Cope (And Failing)

Most hospitals react, not plan. A 2024 report from the Mountain Plains Regional Drug Handicapping and Rehabilitation Services found that 87% of pharmacy directors only learned about a shortage when the delivery didn’t show up. That’s like waiting for a fire to start before calling 911. By then, it’s too late to organize alternatives, train staff, or warn patients.

What should happen? A shortage management team-pharmacists, nurses, IT, risk managers, and finance-should meet weekly. When a shortage hits, they activate within four hours. They check inventory, identify alternatives, update electronic systems, and communicate with clinicians. But only 12% of U.S. hospitals have a formal process like this. The rest are flying blind.

Buffer stocks help. ASHP recommends keeping 14 to 30 days’ worth of critical drugs on hand. But most safety-net hospitals can’t afford it. They’re lucky to hold 8 to 12 days. And even if they do, storage matters. Sterile injectables need clean rooms meeting USP <797> standards. Not every hospital has them. So they stockpile drugs in fridges that aren’t properly monitored. And then wonder why a batch spoils.

What Works: Real Solutions from Other Countries

Other countries don’t wait for disaster. Germany maintains a national strategic stockpile for critical medications. During the 2020-2022 crisis, their shortage impact dropped by 52%. France and Canada require manufacturers to report potential shortages months in advance. That’s mandatory. Not optional. And because of that, shortage duration dropped by 37% compared to the U.S.

In the U.S., reporting is voluntary. Only 65% of manufacturers comply with FDA’s Section 506C rules. That’s like asking drivers to report accidents-and hoping they do. Meanwhile, the FDA’s draft guidance on Risk Management Plans (released in 2022) says manufacturers should map their supply chains, identify risks, and have backup plans. But without penalties, most ignore it.

One promising idea? Reward reliability. Dr. Scott Gottlieb, former FDA commissioner, suggested changing Medicare Part B reimbursement to pay more for drugs from manufacturers with proven quality records. That could unlock $1.5 billion in new investment. Another? Advanced manufacturing tech that lets factories switch between drugs in hours instead of weeks. If 50% of plants adopted this, shortages could drop by 40%.

What You Can Do Right Now

If you’re a clinician, pharmacist, or administrator, here’s what you can do today:

1. Track shortages daily. Bookmark the FDA’s Drug Shortage Database. It’s updated every business day. Don’t wait for an email.
2. Build a local list of alternatives. For your top 10 most-used drugs, identify one or two clinically appropriate substitutes. Know the dosing. Know the risks. Train your team.
3. Use your pharmacy’s inventory system. Set alerts for low stock on critical drugs. Don’t wait for the warehouse to call you.
4. Push for a shortage committee. Even if it’s just you, a pharmacist, and a nurse meeting once a week. Document everything: what happened, what you did, what went wrong.
5. Advocate. Tell your hospital leadership this isn’t just a pharmacy problem. It’s a patient safety issue. Demand funding for buffer stocks and training.

And if you’re a patient? Ask your doctor: “Is this drug in short supply? Are there alternatives?” Don’t assume your treatment is set in stone. Sometimes, a different drug, slightly adjusted dose, or delayed schedule can keep you safe until the original is back.

The Bigger Picture: Why This Won’t Get Better Soon

The Congressional Budget Office projects that without policy changes, drug shortages will rise 8-12% every year through 2030. Oncology, anesthesia, and critical care drugs will be the worst hit. The average shortage now lasts nearly 10 months-up from 6 months in 2015. And the cost? Hospitals spend an average of $218,000 per drug shortage managing the chaos. That’s $1.2 billion a year across the U.S. alone.

This isn’t about running out of Tylenol. It’s about whether a cancer patient gets their next infusion. Whether a heart attack victim gets the right dose of epinephrine. Whether a child in the ICU gets the antibiotics that could save their life.

There’s no single fix. But there’s a path forward: mandatory reporting, financial incentives for quality, strategic stockpiles, and smarter manufacturing. Until then, the burden falls on the people on the front lines-nurses, pharmacists, doctors-who are expected to fix a broken system with no extra time, no extra pay, and no backup.

It’s time we stopped treating medication shortages as an inevitable part of healthcare. They’re not. They’re a failure we can fix-if we choose to.