When I was in pharmacy school, we were taught that drug shortages were rare and usually the result of a shortage of raw materials or interruption in production due to manufacturing quality issues. My, how times have changed.
Fast-forward to 2015. Sodium chloride I.V. solution is now experiencing a shortage. That’s water with salt. The last time I checked, the planet has quite an abundance of both water and salt. It’s also one of the easiest I.V. products to manufacture.
In response to the shortage, the United States is importing the product from Norway, Germany, and Spain. Fortunately, many of the same manufacturing facilities in the United States and these other countries are owned by the same companies. The irony here is stunning: saltwater is being shipped thousands of miles across a literal ocean of saltwater.
What is causing me and most likely other health-system pharmacists not to sleep well at night is the question: Why do we have a saline shortage?
Various manufacturers and FDA officials claim that increased demand is to blame for the shortage, but to my knowledge, they have not provided compelling evidence of the demand. Further, they have not offered a definitive explanation for the supposed increase in demand.
If demand stays the same but supply goes down, then the price goes up. Saline is already a razor-thin margin product for many manufacturers. They cannot control demand, but they can control supply.
This brings to light many frustrating questions. Have they been manipulating supply in a bid to increase their margins? Do drug companies care more about patients or shareholders? There are only three manufacturers of this product in the United States. Does that constitute an oligopoly? (I’m sure my high school economics teacher would be happy right now.)
Perhaps regulators could ask for specific data from manufacturers to support the claims of stable supply and increased demand. Now is the time to investigate if this oligopoly is abusing its power and ask the government to step in to make that determination.
Maybe I should go buy some kosher salt, distilled water, a torsion balance, some empty viaflex bags, and a 22-micron filter—and make my own? I’m just joking to illustrate a point, but in all seriousness, drug shortages are a devastating problem for many health-system pharmacists. It’s certainly an issue that has caused me more than one sleepless night.