How Drug Shortages Are Delaying Treatment and Endangering Patients

When a patient needs a life-saving drug and it’s simply not there, the consequences aren’t theoretical-they’re immediate. A cancer patient waits two weeks for asparaginase. A child with leukemia misses a critical treatment cycle. A heart surgery patient gets a less reliable anticoagulant because heparin is out of stock. These aren’t rare exceptions. They’re happening every day across U.S. hospitals. As of June 2025, there were still 253 active drug shortages, down from a peak of 323 earlier in 2024 but far above the 187 recorded just three years ago. This isn’t a glitch in the system. It’s a breakdown.

What’s Really Behind the Shortages?

It’s easy to blame manufacturers, but the problem runs deeper. About 47% of shortages come from fractured global supply chains. A single active ingredient made in India or China can delay an entire batch of medicine if there’s a factory inspection, power outage, or shipping delay. Then there’s manufacturing quality. Nearly one-third of shortages happen because a plant fails an FDA inspection-often due to contamination or poor documentation. And 21% of cases are caused by raw material shortages, like the chemical precursors for antibiotics or chemotherapy drugs.

The real kicker? Most of these drugs are generics. They’re cheap. And when profit margins are razor-thin, companies stop making them. In 2023, generic drugs made up 83% of all shortages. Why spend millions upgrading a production line for a $0.10 pill when you can make more money on a brand-name drug with a patent? The market doesn’t reward reliability-it rewards cost-cutting.

How Hospitals Are Scrambling to Cope

Hospitals aren’t sitting idle. They’ve formed shortage response teams, bought extra stockpile inventory, and switched to alternative drugs. But it’s not simple. Replacing one drug with another sounds easy until you realize the alternatives might be less effective, more toxic, or require different dosing. One study found that switching to substitute medications led to an 18.3% spike in medication errors. Nurses and pharmacists spend 15 to 20 hours a week per shortage just tracking down supplies, training staff, and rewriting protocols. Pediatric hospitals? They spend 25% more time because kids need special formulations-liquid versions, lower doses, flavoring-that aren’t always available.

In 2023, the average hospital tracked 43 active shortages at once. Some tracked over 70. That’s not just paperwork-it’s constant crisis mode. Pharmacists are forced to call multiple distributors, negotiate with other hospitals, and sometimes beg manufacturers for a few vials. One oncology nurse in Chicago told a reporter she once spent three days trying to get a single dose of nelarabine for a 9-year-old. She got it on the fourth day. The child’s treatment was delayed by two weeks.

Patients Pay the Price-Literally and Physically

When drugs vanish, patients don’t just wait. They suffer. A 2024 NIH analysis showed that during shortages, patients are 43% more likely to make a medication error-taking too much, too little, or the wrong drug. Out-of-pocket costs jump by an average of 18.7% as patients pay for alternatives or pay for faster shipping. Some skip doses. Others stop taking their meds entirely. One in three Americans say they’ve skipped a prescription because they couldn’t afford it, and that number is climbing.

The worst cases are in oncology and critical care. Asparaginase shortages have delayed leukemia treatments by 7 to 14 days. That’s not just inconvenient-it can mean the difference between remission and relapse. Heparin shortages forced cardiac surgery centers to use different anticoagulants, increasing procedure times by 22%. Longer surgeries mean more risk of infection, bleeding, and complications. In one hospital, a patient died after a substitute anticoagulant caused an unexpected blood clot. The family sued. The hospital settled.

What’s Being Done-and Why It’s Not Enough

The FDA started requiring manufacturers to report potential shortages six months in advance in 2023. That’s a step forward. But many companies still wait until the last minute. Others report “potential” shortages that never materialize, flooding the system with noise. The government has held hearings. Congress has debated bills. But no law forces companies to produce low-margin drugs. No policy guarantees supply chain transparency. And no system prevents a single foreign factory from holding millions of American patients hostage.

Some hospitals are turning to group purchasing organizations like Vizient, which helped members avoid $300 million in inventory costs since 2023. Others are investing in real-time monitoring software. But these are band-aids. The real fix? Financial incentives for manufacturers to keep making essential generics. Better oversight of overseas production. Stockpiling critical drugs at the national level. And transparency so hospitals know exactly where a drug is coming from-and when it might disappear.

The Human Cost You Don’t See

Behind every shortage number is a person. A mother who can’t get her child’s ADHD medication. A diabetic who can’t fill his insulin prescription because the batch was recalled. A cancer survivor whose maintenance drug vanished for eight months. One pharmacist in Texas said she cried when a mother asked if her daughter could get her chemo drug “before the next month.” The answer was no. The mother left the hospital without saying another word.

We talk about drug prices. We talk about insurance. But we rarely talk about what happens when the medicine simply isn’t there. No matter how advanced our technology, no matter how many specialists we have, healthcare can’t function without the basic building blocks: pills, injections, IV fluids. When those vanish, the system doesn’t adapt-it fractures.

What Comes Next?

The decline in shortages from 323 to 253 might look like progress. But it’s still far above where we were in 2021. And the root causes haven’t changed. Until manufacturers are financially rewarded for reliability-not just low cost-until supply chains are diversified and monitored, and until patients are protected from the fallout, these shortages will keep coming. And every time they do, someone’s treatment gets delayed. Someone’s health gets worse. Someone might not make it.

The question isn’t whether we can fix this. It’s whether we’re willing to.