Although some shortages stem from temporary manufacturing or distribution problems, many are the result of profound shifts in the economics of the pharmaceutical industry.
In response to increasing financial pressures, drug makers are abandoning older, less profitable products used mainly in hospitals in favor of newer, more lucrative medications tailored to the outpatient market.
Aggravating the problem, hospitals have responded to cost-cutting mandates from managed-care insurers and the government by keeping increasingly small amounts of expensive drugs in their inventories.
This management strategy has left hospitals with scant reserves when new supplies were unavailable.
Although there have been no reports of deaths related to drug shortages, doctors, pharmacists and critical-care unit managers in several cities say the problem has threatened patient care.
Hospitals have been forced to delay some surgeries for months as a result of a shortage of succinylcholine, a drug that helps patients swallow breathing tubes during anesthesia without damage to the esophagus.
Pharmaceutical companies have not stepped up production because they view the market as insufficiently profitable.
Hospital pharmacists and doctors say the problem has reached the point that government intervention is needed, if only to give hospitals more warning of impending shortages.
"We're taking care of patients every day, and the flow of the right pharmaceuticals ... can't be a victim of fluctuations in the marketplace," said Rick Wade, senior vice president for strategic communications at the American Hospital Association.
"This is a time when a regulated marketplace makes sense."
Drug shortages often crop up without warning because federal law does not require companies to give notice of plans to drop a drug unless it is used to treat a life-threatening condition and is made by only one company.
"Shortages often occur even when there are several companies that manufacture a product," said Mark Goldberger, a doctor with the FDA's Center for Drug Evaluation and Research.
"In those cases, they don't have to give notice."
PhRMA, the pharmaceutical industry's trade association, recently convened a meeting to discuss the issue with FDA staffers, doctors, pharmacists and hospital representatives.
"We can't comment on the shortages," PhRMA spokeswoman Jackie Cottrell said.
"There could be a variety of different reasons for different drugs. We really have no information, and individual companies have to address it for their individual circumstances."
There is little dispute that the number of drugs that are in short supply is growing, although there is confusion about when short dosages start and when they are resolved
Of the FDA's roster of hundreds of drugs it categorizes as medical necessities, seven are on its shortage list.
The American Society of Health-System Pharmacists, which tracks a more extensive number of drugs, says about 20 are in short supply.
The society has become a clearinghouse for reported shortages around the country. Joseph Deffenbaugh, a member of its professional practice and scientific affairs division, said he received reports from hospital pharmacists of about 15 to 20 shortages in February, an additional 15 to 20 in March and at least 20 more in April.
Linda Tyler, a pharmacist and director of drug information for the University of Utah Hospital, said 28 drugs were in short supply at her facility in all of 2000. By March of this year, she had added about 10 more.
She said that doctors at the university's psychiatric hospital have not administered electroshock therapy to treat severe depression for several months because of the shortage of succinylcholine and similar drugs.
"I've been in pharmacy management for 20 years, and I've never seen anything like this," said Elaine Levy, who oversees pharmacy supplies for the seven hospitals operated by Sharp HealthCare in Southern California.
"Here we are in an industry that is supposed to be taking care of patients ... and we are begging, borrowing and rationing drugs."
Copyright 2001 Los Angeles Times