Drug Shortages After the Eastern Japan Earthquake: Experiences in a Tertiary Referral Center
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Drug Shortages After the Eastern Japan Earthquake: Experiences in a Tertiary Referral Center
Drug Information Journal 46(5) 607-610 ª The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0092861512448569 http://dij.sagepub.com
Jinichi Mori, MD1, Kenichi Hasui2, Tetsuya Tanimoto, MD3,4, Tomoko Matsumura, MD3, and Masahiro Kami, MD3
Abstract The large earthquake in eastern Japan on March 11, 2011, caused a nationwide drug shortage. The authors investigated the reasons behind the drug shortage and its impacts on clinical practice in a tertiary referral center. From the day the earthquake occurred until September 11, the authors identified shortages of 26 items (2.6% of all drugs in their hospital). The primary shortage causes included the destruction of pharmaceutical plants (n ¼ 24) and packaging factories (n ¼ 1) and a production shift toward other items (n ¼ 1). The nuclear accident at the Fukushima Daiichi nuclear power plant was associated with shortages of 2 items. During the 6-month study period, drug supply of 6 items recovered, alternatives were introduced for 2 items, and prescriptions were restricted for the remaining 3 items. Recoveries were achieved through the repair of damaged factories (n ¼ 18), importation from foreign countries (n ¼ 2), and production in alternate existing factories (n ¼ 1). Physicians avoided long-term prescriptions of all 11 items, and substituted 4 items with similar brand agents, with the informed consent of patients. Although large-scale disasters inevitably cause drug shortages across broad areas even in developed countries, these shortages can be minimized by the coordinated efforts of clinicians and patients. Keywords disaster, pharmaceutical supply chain, nuclear accident, levothyroxine, pharmaceutical company
Introduction
Methods
Drugs are manufactured in pharmaceutical plants, stored by wholesale firms, and then delivered to medical institutions and pharmacies. Most pharmaceutical companies in Japan have adopted the Toyota production system:1 drugs are purposefully manufactured in amounts that will satisfy current demand, meaning the supply chain has little excess inventory. The large earthquake in eastern Japan on March 11, 2011, is likely the first natural disaster that devastated the complex pharmaceutical supply chains of a developed country, causing a nationwide drug shortage. Drug shortages can be detrimental to patients with underlying diseases requiring daily medication; however, little information is available concerning the effect of natural disasters on the drug supply and medical practices in developed countries.2 In addition, the earthquake precipitated the nuclear accident at the Fukushima Daiichi nuclear power plant, which affected most of eastern Japan including the Tokyo area. We investigated the magnitude of the shortage’s influence on the pharmaceutical supply at our hospital in Tokyo during the 6 months following the disaster.
To investigate the reasons behind the drug shortage, we reviewed the pharmacy rec
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