Doctors statewide have come dangerously close to postponing transplant surgeries because immune suppressant drugs are hard to come by; pharmacists are scrambling to find painkillers and general anesthetics to dole out to patients before and after surgery.

And the U.S. Food and Drug Administration is trying to ease the problem by allowing doctors to use "unapproved" foreign drugs.

"It's an absolute epidemic," said Geoffrey Lawton, pharmacy director at the Medical Center of Aurora. "It is hitting hospitals hard. I'm hopeful we don't have to get to the point of rationing. There are certainly alternatives, but they are not as good."

And it's not just one or two drugs they may have to ration. Orders of Levophed, a drug that increases blood pressure after heart surgery, are not being filled. Supplies of Benadryl, an antihistamine, have dropped drastically in Colorado pharmacies, and Narcan, a morphine antagonist that jump-starts a patient's heart, is scarce, pharmacists said.

In April, the Colorado Board of Health suspended requirements for kindergartners to get tetanus boosters before starting school because the sole manufacturer can't produce enough for the nation. Wyeth-Ayerst Laboratories just announced a nationwide shortage of anti-venom medication for snakebites.

"Luckily so far we haven't had to delay transplants because of the shortages, but we've been pretty close," said Dr. Igal Kam, a transplant surgeon at University of Colorado Hospital. "Sometimes you are running all over to different hospitals in town for different medications."

Reasons behind the shortages are many. Pharmaceutical companies say that with so many new drugs on the market, they must be finicky about which ones they choose to produce. The FDA sets stringent standards for production, and making drugs is more expensive than it used to be. Sometimes raw materials don't come in because of a natural disaster - for instance, a hurricane that wipes out a crop that happens to be a key ingredient in a pain-tempering drug.

"We only have so much capacity to produce these drugs, and there are more drugs now," said Doug Petkus, spokesman for Wyeth-Ayerst, one of the nation's largest pharmaceutical companies. "It's a situation that many companies have. Drugs are approved, and their facilities are structured to only make certain lines of product."

Drug shortages have frustrated hospitals for more than a year but have intensified in the past two months, pharmacists said.

The FDA, which has been monitoring the problem and fielding doctors' complaints, recently decided to allow the import of unapproved drugs from other countries to compensate for what U.S. companies aren't producing, said Jason Brodsky, an FDA spokesman.

"We'll help in obtaining another product, and in some cases, that might mean an unapproved product that will come in from another country for a finite period of time," he said.

Brodsky declined to say which drugs are on that status or how often that happens, but he noted that hospitals will know the difference between generic, unapproved drugs and those from pharmaceutical companies in America.

The shortage has spurred hospitals to find alternative markets. Umbrella groups representing pharmacists have recently begun circulating e-mails to hospital pharmacists warning of "black-market distributors" - middlemen who hoard drugs that are in short supply and sell them for more money.

"Hospitals do find these sources and use them," said Dr. Nick Alsever, medical director of Parkview Medical Center in Pueblo. "The shortage problem is increasing expense. You're paying more for stuff in short supply. You run around, you hear about an upcoming shortage and you respond to rumors. We're trying to reserve (the short-supply drugs) for the critical patients."

The scant supply is sending hospital administrators into a tangled goose chase for certain drugs and frustrating doctors who don't want to use substitute medications.

"It's a lot of scrambling, and we still have physicians that as long as it's maybe still available, they'll order that drug. They don't think there's any alternative," Alsever said.

"It's more and more difficult to find an acceptable alternative," said Bill Lowes, pharmacy manager for inpatients at Penrose Hospital in Colorado Springs.

Hospitals can't do without some drugs because they make a big difference when they are needed, said Patti Orma, the clinical coordinator at the Children's Hospital pharmacy.

"One (steroid) that's low right now concerns us because it's really only used when it's needed," she said. "It's going to be pretty bad if we can't get any of it. We try to prioritize patients, but it's very challenging."

Denver Post

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