{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:02:12Z","timestamp":1784005332966,"version":"3.55.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T00:00:00Z","timestamp":1611100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>Management of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>In early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages. This article describes the application of these guidelines to manage the parenteral opioid shortage and the impact on opioid dispensing that occurred in 2018. Our approach paralleled that recommended in the ASHP guidelines. Daily dispensing reports generated from automated dispensing cabinets and from the electronic health record were used to capture dispenses of opioid medications. Opioid prescribing and utilization data were converted to morphine milligram equivalents (MME) to allow clinical leaders and hospital administrators to quickly evaluate opioid inventories and consumption. Action steps included utilization of substitute opioid therapies and conversion of opioid patient-controlled analgesia (PCA) and opioid infusions to intravenous bolus dose administration. Parenteral opioid supplies were successfully rationed so that surgical and elective procedures were not canceled or delayed. During the shortage, opioid dispensing decreased in the inpatient care areas from approximately 2.0 million MME to 1.4 million MME and in the operating rooms from 0.56 MME to 0.29 million MME. The combination of electronic health record alerts, increased utilization of intravenous acetaminophen and liposomal bupivacaine, and pharmacist interventions resulted in a 67% decline in PCA use and a 65% decline in opioid infusions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A multidisciplinary response is necessary for effective management of drug shortages through implementation of strategies and practices for notifying clinicians of shortages and identifying optimal alternative therapies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxaa425","type":"journal-article","created":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T14:42:43Z","timestamp":1611153763000},"page":"426-435","source":"Crossref","is-referenced-by-count":4,"title":["Management of a parenteral opioid shortage using ASHP guidelines"],"prefix":"10.1093","volume":"78","author":[{"given":"Peter","family":"Vo","sequence":"first","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A","family":"Sylvia","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loay","family":"Milibari","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Ryan","family":"Stackhouse","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Szumita","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Rocchio","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Cotugno","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caryn","family":"Belisle","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Goralnick","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua C","family":"Vacanti","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Matta","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Cooley","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Triggs","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Silverman","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Fanikos","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,20]]},"reference":[{"issue":"7","key":"2021021913180359200_CIT0001","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1056\/NEJMp1807117","article-title":"Parenteral opioid shortage-treating pain during the opioid-overdose epidemic","volume":"397","author":"Bruera","year":"2018","journal-title":"N Engl J Med."},{"issue":"6","key":"2021021913180359200_CIT0002","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1001\/jamaoncol.2019.0062","article-title":"Implications of the parenteral opioid shortage for prescription patterns and pain control among hospitalized patients with cancer referred to palliative care","volume":"5","author":"Haider","year":"2019","journal-title":"JAMA Oncology."},{"issue":"2","key":"2021021913180359200_CIT0003","doi-asserted-by":"crossref","first-page":"81","DOI":"10.5055\/jom.2018.0434","article-title":"The parenteral opioid shortage: causes and solutions","volume":"14","author":"Hollingsworth","year":"2018","journal-title":"J Opioid Manag."},{"key":"2021021913180359200_CIT0004","article-title":"The effects of a morphine shortage on emergency department pain control","author":"Brennan","year":"2020","journal-title":"Am J Emerg 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It\u2019s real and could harm cancer patients","author":"Sourmeri","journal-title":"STAT."},{"key":"2021021913180359200_CIT0007","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.2146\/ajhp180441","article-title":"ASHP guidelines on managing drug product shortages","volume":"75","author":"Fox","year":"2018","journal-title":"Am J Health-Syst Pharm."},{"key":"2021021913180359200_CIT0008","author":"Centers for Disease Control and Prevention","year":"2019"},{"key":"2021021913180359200_CIT0009","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/S0885-3924(01)00294-9","article-title":"Equianalgesic dose ratios for opioids: a critical review and proposals for long-term dosing","volume":"22","author":"Pereira","year":"2001","journal-title":"J Pain Symptom Manage."},{"key":"2021021913180359200_CIT0010","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1345\/aph.1H421","article-title":"Opioid conversions in acute care","volume":"41","author":"Patanwala","year":"2007","journal-title":"Ann Pharmacother."},{"key":"2021021913180359200_CIT0011","author":"Food and Drug Administration"},{"issue":"1","key":"2021021913180359200_CIT0012","doi-asserted-by":"crossref","first-page":"74","DOI":"10.7326\/M18-1137","article-title":"Changes in drug pricing after drug shortages in the united states","volume":"170","author":"Hernandez","year":"2019","journal-title":"Ann Intern Med."},{"issue":"5","key":"2021021913180359200_CIT0013","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1001\/jamainternmed.2018.8251","article-title":"Prevalence and severity of rationing during drug shortages: a national survey of health system pharmacists","volume":"179","author":"Hantel","year":"2019","journal-title":"JAMA Intern Med."},{"issue":"18","key":"2021021913180359200_CIT0014","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1001\/jama.2018.13604","article-title":"Group purchasing organizations, health care costs, and drug shortages","volume":"320","author":"Bruhn","year":"2018","journal-title":"JAMA."},{"key":"2021021913180359200_CIT0015","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1111\/jocs.14492","article-title":"The impact of intravenous opioid shortages on postoperative pain control in a pediatric cardiac intensive care unit","volume":"35","author":"Barnes","year":"2020","journal-title":"J Card Surg."},{"issue":"6","key":"2021021913180359200_CIT0016","first-page":"453","article-title":"Impact of drug shortage on medication errors and clinical outcomes in the pediatric intensive care unit","volume":"20","author":"Hughes","year":"2015","journal-title":"J Pediatr Pharmacol Ther."}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ajhp\/article-pdf\/78\/5\/426\/36320843\/zxaa425.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ajhp\/article-pdf\/78\/5\/426\/36320843\/zxaa425.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T01:04:37Z","timestamp":1613869477000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/article\/78\/5\/426\/6104847"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,20]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,1,20]]},"published-print":{"date-parts":[[2021,2,19]]}},"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxaa425","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3,1]]},"published":{"date-parts":[[2021,1,20]]}}}