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

When your hospital runs out of morphine, or the IV antibiotics your patient needs don’t arrive, you don’t get a warning. You just wake up to a phone call: medication shortages are here again. And this time, it’s not just one drug-it’s three. And the next one on the list is saline, which every ICU uses hourly. This isn’t rare. It’s routine.

In 2022, the U.S. faced 287 drug shortages, affecting nearly 1 in 5 essential medications in hospitals. The biggest culprits? Generic sterile injectables-things like morphine, vancomycin, propofol, and IV nutrition. These aren’t fancy new drugs. They’re the backbone of emergency care, cancer treatment, and surgery. And they’re disappearing because a handful of manufacturers-just three companies control 75% of the market-are struggling with quality control. Forty-six percent of all shortages in 2022 were caused by manufacturing failures: dirty equipment, mold in production lines, failed inspections. These aren’t supply chain glitches. They’re systemic breakdowns.

Why This Isn’t Just a Pharmacy Problem

When a drug vanishes, it doesn’t just mean a nurse has to scramble. It means a cancer patient gets delayed treatment. A post-op patient waits 22 minutes longer for pain relief. A rural clinic cancels a procedure because they can’t get antibiotics. Eighty percent of U.S. hospitals report that shortages directly affect patient care. Safety-net hospitals-those serving Medicaid and uninsured patients-are hit hardest. Seventy-eight percent say they’ve had to delay or cancel care because of missing drugs.

It’s not just about running out. It’s about what happens next. Substituting hydromorphone for morphine sounds simple, but it’s not. Dosing is different. Side effects vary. In one hospital, medication errors jumped 15% during a morphine shortage. Nurses had to double-check every dose. Pharmacists spent 12.7 extra hours a week managing the chaos. And none of that was planned.

What Hospitals Are Doing Right (And Wrong)

Some hospitals have figured out how to survive. They don’t wait for the phone call. They build systems.

• They form a shortage response team: pharmacists, nurses, IT, risk managers, and finance staff-all trained to act within 4 hours of a shortage alert.
• They track every shortage in a digital log: when it started, what alternatives were tried, how many errors occurred, who was notified, and how long it lasted.
• They run quarterly simulations. When teams practice switching from one drug to another under pressure, medication errors drop by 33% during real shortages.

But most hospitals can’t do this. Why? Because they’re broke. The average hospital spends $218,000 a year managing just one shortage. That’s more than the salary of a full-time pharmacist. Sixty-five percent of safety-net hospitals can’t even keep a 14-day buffer stock of critical drugs. They’re lucky if they have 8 days. And when the drug runs out, they’re forced to improvise.

The Global Picture: Why Other Countries Handle This Better

France and Canada don’t wait for shortages to happen. They prevent them.

They require manufacturers to report potential shortages months in advance. If a company sees a problem coming-bad batch, equipment failure, raw material delay-they must notify the government. That gives hospitals time to find alternatives, adjust budgets, or stockpile. In those countries, shortage durations dropped by 37% after mandatory reporting started.

The U.S. doesn’t. Manufacturers report voluntarily. And only 65% even bother. The FDA’s system relies on goodwill. It doesn’t work. Meanwhile, Germany keeps national stockpiles of critical drugs-morphine, antibiotics, anesthetics. During the 2020-2022 crisis, their shortage impact fell by 52%. The U.S. has a Strategic National Stockpile, but it’s for bioterrorism and pandemics. Not for everyday drug shortages.

Who’s to Blame? The Real Culprits Behind the Scarcity

It’s easy to point fingers at manufacturers. But the problem runs deeper.

Most generic injectables are made overseas-80% of the active ingredients come from China and India. A single quality failure in a factory in Hyderabad can knock out supply for months. And because these drugs are cheap, manufacturers have little incentive to invest in better equipment or backup production lines. Why spend millions upgrading a facility when you’re selling a vial for $1.50?

Medicare and Medicaid reimbursement rules make it worse. The 340B drug pricing program and Medicaid inflation rebates cap what hospitals can pay for generics. If a manufacturer tries to raise prices to cover quality upgrades, they lose money on government contracts. So they don’t upgrade. They cut corners. And when a plant fails, there’s no backup.

Dr. Scott Gottlieb, former FDA commissioner, put it bluntly: “The incentives in this system are backwards.” If you want to fix shortages, you have to pay manufacturers to be reliable-not just cheap.

What You Can Do Right Now

You don’t need a national policy change to start protecting your patients. Here’s what works today:

1. Know your critical drugs. Make a list: the top 10 medications your unit can’t do without. Check their availability weekly. Don’t wait for the pharmacy to tell you.
2. Build a shortlist of alternatives. For each critical drug, identify one or two clinically appropriate substitutes. Know the dosing differences. Train your team on them. Don’t wing it during a crisis.
3. Track your own data. Start a simple log: when a drug runs out, how long it lasted, what you used instead, and if any errors occurred. You don’t need fancy software. A shared Google Sheet works.
4. Ask for help early. If you see a drug order is late or reduced, flag it immediately. Don’t wait for the official shortage notice. Most shortages are announced after the fact. By then, it’s too late.
5. Push for a shortage committee. Even if your hospital doesn’t have one, start one. Get pharmacists, nurses, and admins together. Meet once a week. Make it part of your routine.

What’s Changing? And Will It Be Enough?

The federal government is trying. In 2022, HHS created a new role: Supply Chain Resilience and Shortage Coordinator. The FDA is finalizing new rules in 2024 that will require manufacturers to give earlier warnings. That could improve detection by 25%.

Some hospitals are testing advanced manufacturing tech-machines that can switch between drug production in hours, not weeks. If adopted widely, this could cut shortages by 40%. But it’s expensive. And it won’t help the 63% of shortages caused by quality failures in aging overseas plants.

The American College of Physicians is pushing for Medicare to reward reliability-not just low cost. If hospitals paid more for drugs from manufacturers with clean inspection records, companies would finally have a reason to invest in quality. That change could bring in $1.5 billion in new funding for infrastructure.

But here’s the truth: none of this will fix the problem overnight. The U.S. is on track for an 8-12% annual increase in shortages through 2030. Oncology, anesthesia, and critical care drugs will be hardest hit.

Bottom Line: Prepare Now, Because Waiting Is Dangerous

Medication shortages aren’t going away. They’re getting worse. And the people who suffer most aren’t CEOs or lawmakers-they’re the patients waiting for pain relief, antibiotics, or cancer treatment.

You can’t control the supply chain. But you can control your response. Build your team. Know your alternatives. Document your decisions. Train your staff. Don’t wait for the system to fix itself. Because if you do, someone’s care will slip through the cracks.

The next time a drug doesn’t arrive, don’t panic. Have a plan. Because in healthcare, when the medicine runs out, the only thing left is your judgment-and your preparation.