美国国家公共电台 NPR Doctors Raise Alarm About Shortages Of Pain Medications

 

DAVID GREENE, HOST:

And we are learning more this morning about an opioid crisis different from the one we usually cover. This one is playing out in hospitals around the country. Anesthesiologists and other doctors are facing shortages of injectable opioids. These drugs, like liquid morphine and fentanyl, are used to control pain in critical care settings like surgery, intensive care units and hospital emergency departments. From Dallas, NPR's Wade¹ Goodwyn has more.

WADE GOODWYN, BYLINE²: In the pediatric intensive care unit at a major Dallas hospital, nurses attend to their small patients.

UNIDENTIFIED NURSE: You doing OK?

(SOUNDBITE OF HOSPITAL ROOM MACHINE BEEPING)

GOODWYN: These are critically ill children with both medical and surgical³ problems. The injectable pain medications morphine, hydromorphone and fentanyl are the mainstays of intravenous pain control and sedation in critical care settings. And across the country, hospitals and other medical facilities have been running low and out of the supplies they need.

RED STARKS: It escalated⁴ late this spring when we didn't have any morphine.

GOODWYN: Dr. Red Starks is a pediatric anesthesiologist who's been practicing for 26 years.

STARKS: One week, we had morphine, but we didn't have Dilaudid. And two weeks later, we've got a little trickle⁵ of Dilaudid, but we didn't have any morphine. And you're just thinking, hello, am I in the 21st century?

GOODWYN: Starks says that while there have been periodic shortages of pain medications in the past, it's never been this serious. Patients remain largely unaware⁶ of these obstacles to their pain management. Hi there, I just wanted to let you know we've been running low on pain meds is not the conversation starter anesthesiologists are going to use with their patients in pre-op. Of course, it's not just anesthesiologists who are affected⁷. The number of medical situations where physicians use injectable opioids is considerable. But it's the anesthesiologists who are most distressed⁸ because it's their job to mitigate⁹ patient pain. Dr. Jim Grant is president of the 53,000-member American Society of Anesthesiologists.

JIM GRANT: Now we have it every day. We go in - what do we have today, what don't we have today? It's not unusual for me to get a call from the pharmacist, we have X number of this left, we're working on a somewhat of a contingency¹⁰ plan.

GOODWYN: Grant says in addition to Dilaudid, morphine and fentanyl, his members report shortages of bupivacaine, a local anesthetic¹¹, and the lifesaving drug epinephrine. Why? Well, pharmaceutical¹² industry consolidation¹³ means where once there were many manufacturers, now there are a few. So a production interruption at any one plant can cascade¹⁴ into a serious shortage.

GRANT: We need more than one or two factories in a country of our size to be producing some of these essential drugs.

GOODWYN: You might think that if one drug manufacturing company is having serious production problems, it's an obvious opportunity for competitors. But the industry says that's not the way it works. Here's Matthew Kuhn, with the global pharmaceutical giant Fresenius Kabi.

MATTHEW KUHN: For a company like Fresenius Kabi to try and pick up the production slack from another company is complicated. Sterile¹⁵ injectable drugs are a complex manufacturing process to begin with, and then you have to increase production. You're essentially¹⁶ competing within your own factory for space and time.

GOODWYN: Still, Fresenius Kabi says it's trying to help.

KUHN: In the case of the injectable opioids, we have increased production. We have extended shifts. We have added workers. But one company is not going to be able to, you know, completely fulfill¹⁷ all the market needs for clinicians and their patients.

GOODWYN: Pfizer is one of those manufacturers that's had some production issues of late. Pfizer believes it's now got its problems resolved and, in a statement to NPR, said, we recognize the importance of these medications to patients and physicians and are committed to resolving these shortages as quickly as possible. So where's the federal government on all this? On the one hand, the DEA is trying to get a grip on an opiate addiction¹⁸ and overdose crisis that is killing¹⁹ thousands of Americans. So the DEA is trying to control supply.

On the other hand, the Food and Drug Administration is getting an earful from thousands of doctors, dozens of hospitals and, last but not least, 16 U.S. senators who wrote a stern letter demanding the FDA do something about this drug shortage, which the FDA would like to do, if it could. Here's Valerie Thompson, the associate director of the FDA's Drug Shortages department.

VALERIE THOMPSON: Well, I think one thing to remember is FDA doesn't control how much manufacturers make and can't order a manufacturer to make any product. So it's really up to the market to decide, you know, which drugs to make and how much.

GOODWYN: The FDA is concentrating on growing the number of suppliers, searching and expediting approval of additional sources, which is no easy task. You can't exactly buy sterile hydromorphone from the Keebler elves. Wade Goodwyn, NPR News, Dallas.

1 wade   

v.跋涉，涉水；n.跋涉

参考例句：

• We had to wade through the river to the opposite bank.我们只好涉水过河到对岸。
• We cannot but wade across the river.我们只好趟水过去。

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。

4 escalated   

v.（使）逐步升级( escalate的过去式和过去分词 )；（使）逐步扩大；（使）更高；（使）更大

参考例句：

• The fighting escalated into a full-scale war. 这场交战逐步扩大为全面战争。
• The demonstration escalated into a pitched battle with the police. 示威逐步升级，演变成了一场同警察的混战。

5 trickle   

vi.淌，滴，流出，慢慢移动，逐渐消散

参考例句：

• The stream has thinned down to a mere trickle.这条小河变成细流了。
• The flood of cars has now slowed to a trickle.汹涌的车流现在已经变得稀稀拉拉。

6 unaware   

a.不知道的，未意识到的

参考例句：

• They were unaware that war was near. 他们不知道战争即将爆发。
• I was unaware of the man's presence. 我没有察觉到那人在场。

7 affected   

adj.不自然的，假装的

参考例句：

• She showed an affected interest in our subject.她假装对我们的课题感到兴趣。
• His manners are affected.他的态度不自然。

8 distressed   

痛苦的

参考例句：

• He was too distressed and confused to answer their questions. 他非常苦恼而困惑，无法回答他们的问题。
• The news of his death distressed us greatly. 他逝世的消息使我们极为悲痛。

9 mitigate   

vt.（使）减轻，（使）缓和

参考例句：

• The government is trying to mitigate the effects of inflation.政府正试图缓和通货膨胀的影响。
• Governments should endeavour to mitigate distress.政府应努力缓解贫困问题。

10 contingency   

n.意外事件，可能性

参考例句：

• We should be prepared for any contingency.我们应该对任何应急情况有所准备。
• A fire in our warehouse was a contingency that we had not expected.库房的一场大火是我们始料未及的。

11 anesthetic   

n.麻醉剂，麻药；adj.麻醉的，失去知觉的

参考例句：

• He was given a general anesthetic.他被全身麻醉。
• He was still under the influence of the anesthetic.他仍处在麻醉状态。

12 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

13 consolidation   

n.合并,巩固

参考例句：

• The denser population necessitates closer consolidation both for internal and external action. 住得日益稠密的居民，对内和对外都不得不更紧密地团结起来。 来自英汉非文学 - 家庭、私有制和国家的起源
• The state ensures the consolidation and growth of the state economy. 国家保障国营经济的巩固和发展。 来自汉英非文学 - 中国宪法

14 cascade   

n.小瀑布，喷流；层叠；vi.成瀑布落下

参考例句：

• She watched the magnificent waterfall cascade down the mountainside.她看着壮观的瀑布从山坡上倾泻而下。
• Her hair fell over her shoulders in a cascade of curls.她的卷发像瀑布一样垂在肩上。

15 sterile   

adj.不毛的，不孕的，无菌的，枯燥的，贫瘠的

参考例句：

• This top fits over the bottle and keeps the teat sterile.这个盖子严实地盖在奶瓶上，保持奶嘴无菌。
• The farmers turned the sterile land into high fields.农民们把不毛之地变成了高产田。

16 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

17 fulfill   

vt.履行，实现，完成；满足，使满意

参考例句：

• If you make a promise you should fulfill it.如果你许诺了，你就要履行你的诺言。
• This company should be able to fulfill our requirements.这家公司应该能够满足我们的要求。

18 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

19 killing   

n.巨额利润；突然赚大钱，发大财

参考例句：

• Investors are set to make a killing from the sell-off.投资者准备清仓以便大赚一笔。
• Last week my brother made a killing on Wall Street.上个周我兄弟在华尔街赚了一大笔。