Shortages Force Paramedics To Use Expired Drugs

Many of us have probably popped a pill or two that we knew had passed its expiration date. But when you get medical care from professionals, there is usually the expectation that you’re getting the freshest stuff available. But a conspiracy of conditions has led to some emergency responders stocking their ambulances with out-of-date drugs.

“We’ve never (before) had to go diving back into the bin to try to retrieve expired boxes of drugs,” a rep for the fire department in Bend, Oregon, explains to the Associated Press. “We had the backing of our insurance company that giving expired drugs is better than giving no drugs at all.”

Some paramedics in Bend have been using expired drugs for about a year, reports the AP.

The rep says that, even though there’s a chance that expired meds might not work as well as drugs fresh from the manufacturer, no adverse reactions have been reported.

Health officials in Oregon recently voted to allow the carrying of expired drugs in ambulances. Arizona regulators have agreed to not fine first responders for running out of the drugs they are required to stock.

The AP cites a report from the University of Utah’s Drug Information Service that claims 275 medications are currently in short supply.

Paramedics say they have been hit particularly hard by shortages on Valium, dextrose 50 (for treating diabetics) magnesium sulfate (for eclampsia), as well as good ol’ painkillers and sedatives.

The supply of fresh epinephrine, used to treat heart attack patients and those with severe allergic reactions, is in danger of becoming low, say first responders.

So what’s behind the shortages?

From the AP:

Manufacturing quality lapses, production shutdowns for contamination and other serious problems are behind many of the shortages, according to manufacturers and the FDA. Other reasons include increased demand for some drugs, companies ending production of some drugs with small profit margins, consolidation in the generic drug industry and limited supplies of some ingredients.

Manufacturers say it could be a while before the supply of these drugs is back up to acceptable levels.

In addition to expired drugs, some healthcare providers are using alternative drugs that may have additional side effects or cost more than the standard drugs. There is also the option of diluting some meds to stretch the supply out.

“It has such significant risk of patient harm or provider error that it’s worthy of immediate attention,” said the director of the National Association of State EMS Officials.

The FDA allows the use of certain batches of expired drugs if they have been tested and proven to still be safe.

“The FDA is looking into solutions that would assist first responders and hospitals to use expired medications that they may have on hand during a shortage,” said an FDA rep, “if there is data to support the medicine is safe and effective for patients,”

Some paramedics turn to expired drugs due to shortages [KATU.com]

Thanks to Amy for the tip!

Comments

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  1. daemonaquila says:

    I have to give this a huge Meh. Most docs know which meds are perfectly fine beyond their expiration date, and will make the choices judiciously. Meds aren’t just perfectly fine one day, then magically go bad the day that’s printed on the bottle. This is more a crisis for Big Pharma, which is not making as much money if people stretch the med expiration dates or use alternative drugs.

    • shufflemoomin says:

      I think the fact that you think a paramedic and a doctor are the same thing invalidates your opinion.

      • Difdi says:

        I like the fact you think a paramedic can prescribe medication just like a doctor invalidates your opinion.

        • shufflemoomin says:

          I didn’t say a paramedic wasn’t licensed to USE drugs, because they are. They do not, however, have the same level of education as a doctor or pharmacist, therefore not qualified to make such decisions about what is safe and what isn’t.

  2. spartan says:

    Didnt the supreme Court of one state or another recently block an execution, because it would have meant the condemned prisoner would be given an expired medication?

  3. RadarOReally has got the Post-Vacation Blues says:

    It seems to me that the FDA needs more power to actually do something about production standards. You may argue that more regulations to follow slow things down, but since the end result of fewer regulations is that the final quality becomes so bad that at some point the manufacturer has to stop selling its product, prevention seems like the better option.

    And yet, we have a strong trend toward deregulation.

    • KyBash says:

      It’s my understanding that the main issue in some case was a lack of regular inspections.

      Instead of being cited for minor things that could be handled quickly, and which would remind everyone to observe proper protocols, things were ignored until they were so major that closing the plant was the only option.

  4. lovemypets00 - You'll need to forgive me, my social filter has cracked. says:

    I’m more concerned about this statement “Manufacturing quality lapses, production shutdowns for contamination and other serious problems are behind many of the shortages”.

    What kinds of problems are occurring at facilities that are still operating? In these days of high unemployment, can’t they find qualified workers who can follow manufacturing protocols? I’d love to see all the data behind that statement.

    • Blueskylaw says:

      I would bet that as profits DECLINE, manufacturing quality lapses, production shutdowns, contamination, and other serious problems INCREASE.

      Of course, one of the unfortunate side effects of these calamitous coincidences are rising prices.

  5. Blueskylaw says:

    It’s actually interesting to note that the expired drugs weren’t discarded after they expired. I wonder what the actual policy is on expired drugs and how long they hold onto them after they expire. Also, like daemonaquila said, Big Pharma must be getting themselves into a lather knowing that expired drugs are being used and sales are being lost due to this decision. Who wants to bet that within a week, a study (funded by Big Pharma) will come out claiming that an expired drug (even by one day) is somehow deleterious to the publics health and should NEVER, EVER, EVER be used.

    • lovemypets00 - You'll need to forgive me, my social filter has cracked. says:

      My doctor told me that aspirin, and things like that, are good beyond the expiration date. I take care to store them in a cool, dark place, and not on the windowsill, so if I grab my generic WalMart “Excedrin Extra Strength”, and it’s a few months out of date, I don’t worry about it.

    • Bladerunner says:

      A lot of places hold onto expired meds for “proper disposal”, because they don’t want to just throw expired narcs into landfills. I believe there’s also some credit that can be obtained from some manufacturers based on contracts, but thanks to all the controls on drugs, they want to ensure they are really disposed of and not “diverted” (technical pharmacy talk for “stolen”)

    • Feral Ginger says:

      I’m in a veterinary hospital, and quite a few of our expired drugs end up in dirt poor hospitals in Puerto Rico.

  6. LorenPechtel says:

    The real problem here is that the government has forced the price of the drugs so low that it’s not in the manufacturer’s interest to maintain any reserves. Thus any little glitch translates into supply problems.

    • Blueskylaw says:

      “The real problem here is that the government has forced the price of the drugs so low”

      Drug makers increased their prices last year by an average of 7.4 percent for brand-name meds most commonly prescribed to the elderly, and the increase was about 2.5 times the overall inflation rate, according to AARP, which released the report and has been tracking prices charged to wholesalers since 2002.

      In discussing the findings, AARP notes the price increases have been slightly greater since the Medicare drug benefit began Jan. 1, 2006, the Associated Press reports. In the four years before the benefit, wholesale prices rose between 5.3 percent and 6.6 percent annually, according to AARP.

      • Libertas1 says:

        The actual year over year inflation rate is about 10%.

        • Blueskylaw says:

          The actual LONG term average annual inflation rate is 3.43%. Not sure where you got 10% from, that’s a helluva high number.

    • SirWired says:

      Did you just type that with a straight face?

      Of all the govt. programs, only Medicaid has any price controls whatsoever, and even that merely states that if somebody else (i.e Medco) is getting a drug for cheap, it has to be sold to Medicaid for the same price. Not a lesser price, not some sort of permanently fixed price, not a “fair” price, just the same price that the drug is being sold elsewhere in the US.

      No other government drug program has price controls of any sort. At all. Not even the Medicare drug program.

      • fenriswf says:

        All government entities get the Federal Contract Price which makes all other pharmacies and hospitals salivate. It is **WAY** lower than what the others get including Medicare. The military, federal prisons, public health (Native American reservations, etc).

  7. shufflemoomin says:

    Stories like this have be brought up to those “USA Number one” people when the state of New Orleans isn’t enough to remind that them all is not rosy in the US and they’re not “above all countries” as they seem to think. I’m shocked this is being allowed.

  8. Libertas1 says:

    Hard pills are shelf stable for 10 years as is required by the military.

    • Blueskylaw says:

      Sometimes though, the military is a hard pill to swallow.

    • Bladerunner says:

      The only hard pills medics carry in my experience are baby aspirin and nitro, and nitro is not shelf stable for 10 years, particularly after the bottle is open.

      Almost everything else is liquid for IV administration.

      • muzz3256 says:

        In my area we recently started carrying oral Zofran (Ondansetron), that way we don’t have to start an IV just to give an antiemetic (drug that reduces or stops nausea and vomiting). It’s an orally dissolved pill much like Nitro, just have the patient place the pill under their tongue and let it dissolve. Works wonders….

    • fenriswf says:

      Been doing pharmacy in the USAF for 23 years, wrong answer :) We have stockpiles of medications that you would have for Public Health outbreaks and biological incidents, but we do not keep meds for 10 years. As soon as that expiration date hits they are pulled. Will tablets stay good for that long? Storage, storage, storage! It is all about temp, humidity, and light exposure. We have a wharehouse, a small one, that use to keep the stuff we would deploy with, those drugs were checked monthly for expiration.

  9. sir_eccles says:

    I can imagine the outcry next week when the headline reads:

    “Paramedics import drugs from China to replenish stocks”

  10. JJFIII says:

    There are two major issues at play in my eyes.
    1. Create a shortage, which translates into a supply an demand situation. The drug companies can then ramp up production once the price they want from contracts with insurance companies and the government get to where they want them
    2. The drugs may still be safe BUT, I am betting they will still be billed for drugs that have no more effect than a placebo. I have no issue with this if two things happen, first informed consent and two, no charge for the expired meds. I can check the expiration date on milk and decide if I want to drink it, but doctors and paramedics do not present meds like they do a bottle of wine for approval.

    • Bladerunner says:

      Some of these drugs you can’t ask for informed consent.

      If you’re seizing, and all we have on hand is expired diazepam, and you’re in status epilepticus and could die, what would you like the medics to do?

      • JJFIII says:

        Obviously in a situation where they would not ask for consent anyway they can go ahead and give it. BUT they should also tell you after you are capable the drugs they gave you and that it was an expired dose. That is the problem with the medical care in this country to begin with. the average person does not know what a medical care provider is putting n your body and people trust their doctor.
        The patient should be the one making the risk benefit analysis. I

  11. dush says:

    Expired doesn’t necessarily mean dangerous or ineffective.

  12. Feral Ginger says:

    I’m in the veterinary field, and we’ve been completely without Valium for about a year. We had to switch up our preferred protocol and use its cousin Midazolam, but that’s been out for about 6 months now. Understandably, human hospitals take priority when small amounts of these drugs hit the market, so we’ve been using alternate cocktails. But damn, Ket/Val just worked so good. Come back, we miss you *reaches out to a photo of a valium bottle*

  13. SilverBlade2k says:

    I can just imagine what kind of lawsuits would fly if any adverse effects were to happen..such as..I dunno..death?..

  14. Peri Duncan says:

    Hey! Did they get the idea for this story from my earlier post/link on the SlowFe thread? Do I get a commission?

    • Peri Duncan says:

      And since the “problems” with the link, why does this site no longer post my pseudonym, but my real name?

      • Blueskylaw says:

        Hello Peri !!!!

        • mulch says:

          Back in the 50’s, one of our local pharmacists in NC used to drive to New York City and sell his expired drugs to jazz clubs. He owns a chain of nursing homes now, among other things. It was a good gig, when you could get it.

  15. Caveqat says:

    His opinion is entirely valid. As a rescue specialist, i worked along side the medics, and the doctors. I’d rather have the medic then the doctor treat me in an emergency situation. Better treatment. Been on the other side of the scalpel several times, and the
    Drs are better in non-emergency sit’s then medics, but thats training. Like a mechanic are the best ones, are wrench schooled.

  16. Loco179 says:

    Been using expired drugs for over a year now. The only issue I have is the Docs telling us not to use pain meds as much.

  17. trencherman says:

    If you have a friend who’s a pharmacist, ask them what they think about this. Obviously the pharmacist you ask in a store or hospital has to tell you the party line.
    Two of my friends are pharmacists that in most cases (especially if the medication isn’t “live” but rather just some chemical concoction) chances are it’s good for a looooong time. I believe that after the expiration date the drug is not guaranteed to be 99.9% effective, or some such thing. In my opinion, 99.2% effective is just fine. I used to work for a pharmacist (a long time ago I was a pharmacy tech) who thought that this was all just an invention by the big pharmaceutical companies with the purpose of making more money.