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A crisis within an epidemic: critical opioid shortage in US hospitals
  1. Bo Wang1,
  2. Norman L Downing2,3
  1. 1 Medicine, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
  3. 3 Department of Medicine, Clinical Excellence Research Center, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Bo Wang, Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; bo_wang{at}alumni.harvard.edu

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Introduction

The overprescribing and misuse of prescription and non-prescription opioid painkillers has led to an epidemic of addiction and overdose. In 2016 alone, 42 249 deaths were attributed to opioid overdose in the USA, five times higher than in 1999 and higher than the annual number of deaths attributed to motor vehicle accidents or firearms.1 2

In response, the Trump administration has declared the opioid epidemic a national ‘public health emergency’,3 directing US$6 billion in additional funds towards combatting this crisis, including for substance abuse treatment and mental health services, addiction research and diversion prevention efforts.4 5 However, in the midst of these efforts and the attention that has been focused on them, a seemingly oxymoronic crisis has emerged—critical shortage of injectable opioids in our nation’s hospitals.

Shortage of injectable opioids

In June 2017, on the heels of a warning letter from the US Food and Drug Administration (FDA) for violations of good manufacturing practices, Pfizer, which produces of almost two-thirds of US’s injectable opioids, began cutting back production of these drugs during an upgrade of its manufacturing plant in McPherson, Kansas.6 These injectable opioids include some of the most commonly administered painkillers for hospitalised patients, including hydromorphone, fentanyl and morphine.

With production at the Pfizer plant not expected to normalise through at least the first half of this year, and other injectable opioid manufacturers unable to scale up production to meet demand, shortage of these medications has …

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