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

When a life-saving drug disappears from the shelf, it’s not just an inconvenience-it’s a crisis. In 2022, the U.S. faced 287 drug shortages, affecting nearly one in five essential medications in hospitals. These aren’t rare glitches. They’re systemic failures that hit hardest in cancer care, emergency rooms, and rural clinics. If you’ve ever waited hours for a saline bag, switched from morphine to hydromorphone because the original ran out, or watched a patient’s treatment get delayed because the IV antibiotic wasn’t in stock-you know how real this is.

Why Do Medication Shortages Keep Happening?

Most shortages aren’t caused by sudden spikes in demand. They’re rooted in broken manufacturing and economic incentives. Over 60% of all drug shortages involve generic sterile injectables-things like morphine, antibiotics, chemotherapy agents, and IV fluids. These are cheap drugs, made in bulk, often by just three manufacturers who control 75% of the U.S. market. When one factory has a quality issue-a leaky pipe, mold in the clean room, or a mislabeled batch-the whole supply chain stalls.

The FDA found that 46% of shortages in 2022 were due to manufacturing quality problems. That’s down from 62% a decade ago, but still the top cause. Why? Because there’s little financial incentive for companies to invest in better equipment or backup systems. Generic drug prices are locked in by Medicaid rebates and 340B program rules. If a manufacturer tries to raise prices to cover upgrades, they lose sales in the very markets that rely on those drugs the most.

Add to that: 80% of the active ingredients in U.S. drugs come from overseas, mostly China and India. A single flood, political disruption, or inspection delay abroad can ripple through American hospitals. The average shortage now lasts 9.8 months. For cancer drugs, it’s over 14 months.

What Happens When a Drug Disappears?

It’s not just about running out of pills. It’s about chaos.

Pharmacists scramble to find alternatives. Nurses get retrained on new dosing protocols. Doctors face impossible choices: delay surgery, use a less effective drug, or risk a dangerous substitution. In one 2023 case, a hospital switched from saline to dextrose for IV hydration because saline was unavailable. Patients developed electrolyte imbalances. Errors jumped by 15%.

The burden falls hardest on safety-net hospitals serving Medicaid and uninsured patients. 78% of these facilities report canceling or delaying procedures due to drug shortages. Meanwhile, pharmacy teams are working 12.7 extra hours per week on average just to manage the fallout. Nurses report patient wait times for critical meds increasing by 22 minutes.

And it’s not just hospitals. 84% of physician practices in the U.S. dealt with at least one shortage in 2022. One in five patients had their treatment changed because the prescribed drug wasn’t available.

How Hospitals Are Trying to Cope

Some hospitals have built systems to fight back. The most effective ones have a dedicated shortage management team: pharmacists, nurses, IT staff, risk managers, and finance officers-all trained to act fast.

Here’s what works:

• Weekly shortage committee meetings-even when there’s no crisis. This keeps everyone alert.
• Real-time tracking systems that flag when a drug order is delayed or reduced, not just when it’s gone.
• Buffer inventories of 14-30 days for critical drugs. But here’s the catch: only 35% of hospitals can afford this. Most safety-net hospitals keep just 8-12 days’ worth.
• Simulation drills every quarter. Hospitals that run these see 33% fewer medication errors during actual shortages.
• Clear communication protocols-updates sent to staff within 4 hours of a shortage being confirmed.

The Mountain Plains Regional Drug Handicapping and Rehabilitation Services (MPRDHRS) project found that hospitals using these practices reduced patient harm by over 40%. But these systems cost money. And not every hospital has it.

What Are Your Alternatives?

When your usual drug is gone, you need options. But not all alternatives are equal.

For example:

• Morphine shortage? Hydromorphone is a common substitute, but it’s 5-7 times more potent. Dosing errors spike without clear protocols.
• Vancomycin unavailable? Linezolid or daptomycin may work, but they’re far more expensive and require different monitoring.
• IV saline gone? Dextrose or lactated Ringer’s can be used, but they don’t replace electrolytes the same way. This can lead to complications in trauma or sepsis patients.

The key is having a pre-approved list of alternatives-vetted by your pharmacy and therapeutics committee-and training staff on them before the shortage hits. Waiting until the last minute is how mistakes happen.

What’s Being Done to Fix This?

There’s movement, but it’s slow.

In 2022, the U.S. Department of Health and Human Services created a new role: Supply Chain Resilience and Shortage Coordinator. Their job? To coordinate between the FDA, CDC, and manufacturers. They’ve started building a national response framework, but it’s still in early stages.

The FDA is also pushing manufacturers to submit Risk Management Plans under new draft guidance. These plans must include:

• Supply chain mapping (who supplies what, where)
• Quality control thresholds (what triggers a shutdown)
• Contingency plans for production failures

If finalized in 2024, this could improve early detection by 25%. But it’s still voluntary for now.

Countries like Germany and Canada have mandatory reporting and national stockpiles. Germany’s strategic reserves cut shortage impacts by 52% during the pandemic. The U.S. has no such system for routine drug shortages-only the Strategic National Stockpile, which is reserved for disasters like bioterrorism or pandemics.

Experts like former FDA Commissioner Dr. Scott Gottlieb argue that Medicare Part B reimbursement needs to change. Right now, hospitals get paid the same whether a drug is cheap and reliable or expensive and unstable. If reimbursement rewarded reliability, manufacturers would have real incentive to fix their lines.

What Can You Do?

If you’re a patient: Keep a list of your medications and their generic names. Ask your pharmacist: “Is this drug in short supply? What are the alternatives?” Don’t assume your prescription will be filled the same way next time.

If you’re a healthcare worker: Advocate for your hospital to build a shortage response team. Push for regular training. Document every substitution and error-it’s the only way to prove this is a systemic problem.

If you’re a policymaker or advocate: Support legislation that funds buffer inventories for safety-net hospitals. Push for Medicare reimbursement reform. Demand transparency from manufacturers.

What’s Next?

Without major changes, drug shortages will grow by 8-12% per year through 2030. Oncology, anesthesia, and critical care drugs will be hit hardest. The cost to hospitals? Over $1.2 billion a year just to manage the chaos.

The problem isn’t going away. But it’s not inevitable. The tools to fix it exist: better manufacturing, smarter incentives, national coordination, and preparedness. What’s missing is the political will to make it happen.

Until then, the people on the front lines-pharmacists, nurses, doctors-will keep making do. With less. With more stress. And with the constant fear that the next missing drug might be the one that saves someone’s life.

Final Thoughts

Medication shortages aren’t a future problem-they’re happening now. Every day, someone’s treatment is delayed, a nurse works extra hours, or a patient is put at risk because a simple vial of medicine isn’t there. The solutions exist: better manufacturing, smarter policies, and stronger preparedness. But they require action-not just from manufacturers, but from regulators, hospitals, and patients too. The next time you hear about a drug shortage, don’t think it’s someone else’s problem. It’s everyone’s.