A nationwide shortage of the liquid form of a crucial painkiller is forcing South Sound hospitals to adjust procedures and use alternative drugs.
The painkiller hydromorphone, derived from morphine and known by the trade name Dilaudid, is a powerful opioid used to treat severe pain associated with cancer, surgery, trauma and more.
In its injectable form via syringe, hydromorphone is 20 times more potent than oral morphine, according to the Stanford School of Medicine.
“Hydromorphone is used quite a bit because it’s a little easier to manipulate than fentanyl, which is very potent,” said Steve Fijalka, the head of the pharmacy at Harborview Medical Center in Seattle.
The drug is preferred to morphine for patients with kidney problems because “it doesn’t have quite the frequency of (adverse effects),” he said.
While shortages have not affected the oral form of hydromorphone, pills cannot be easily substituted for the injectable form.
For instance, oral medicines are not an option for surgery patients or those who must use breathing tubes and cannot swallow pills.
The shortage of injectables started in October after upgrades to a Pfizer Inc. manufacturing plant in Kansas slowed production. The company said it would try to compensate with increased production of alternative products.
“However, there will be times when inventory is not available and specifically, the Hydromorphone Hydrochloride Injection ... will be on long-term back order,” the company said.
Out of 35 injectable hydromorphone products normally offered by one wholesaler, for example, only three were available recently, Fijalka said.
A spokesman for Providence St. Peter Hospital in Olympia acknowledged that hydromorphone injectables are in short supply there.
“Because of the shortage, we have recently reached out to our medical and nursing staffs and asked them to reserve the use of hydromorphone for those patients who absolutely need it, and use a substitute such as fentanyl or morphine where it is appropriate,” spokesman Chris Thomas said.
“This is being done to ensure we continue have hydromorphone for those patients whose specific care needs call for its use.”
According to records obtained by The News Tribune, an emergency meeting was held Jan. 5 at St. Peter to discuss how the shortage was affecting the hospital and to devise a plan to respond.
“If a patient has an order for intravenous hydromorphone, please contact the provider to order an alternative agent, such as oral agents, IV fentanyl, or IV morphine,” stated a memo to providers and nursing staff.
The memo also said the drug was being removed from dispensing machines at St. Peter.
“Any remaining stock will only be available through the central pharmacy, to patients with severe intolerance to alternative agents, or critically ill patients with renal failure,” the memo stated.
In Pierce County, a spokesman for CHI Franciscan’s St. Joseph Medical Center in Tacoma said the hospital’s supplies were adequate.
“Patient care is not being impacted at any CHI Franciscan facility,” said Cary Evans, who did not provide specifics or additional information.
Spokesman Mark Swart said Tacoma General Hospital has an adequate supply of hydromorphone.
But he added that the hospital’s drug wholesaler has implemented restrictions to ensure hospitals and organizations “don’t order everything” the wholesaler has in stock and deplete its supply.
At Harborview, Fijalka said, “We’ve had to do that with hydromorphone to make sure that the patients continue to get it. We haven’t had to ration it or not give it to appropriate patients.”
Substituting other drugs for hydromophone must be carefully done.
Because different drugs have differing strengths and side effects, physicians, nurses or pharmacists must convert an order for one painkiller into the correct dosage for another. Factors including a patient’s metabolism, tolerance and history must be taken into account.
Hydromorphone is only one of several drugs experiencing shortages around the nation. The Federal Drug Administration maintains a list of drugs that are in shortage. It currently has more than 70 listed.
“Basic things like lidocaine are in short supply now,” Fijalka said. “It’s just very frustrating.”
Craig Sailor: 253-597-8541, @crsailor
This story was originally published January 18, 2018 2:30 PM.