Right now, if you or someone you know needs a simple IV saline bag, a chemotherapy drug, or even a common antibiotic, there’s a real chance your pharmacy won’t have it in stock. This isn’t a temporary glitch-it’s a nationwide crisis that’s been building for years and is now at its worst level since tracking began in 2001. As of April 2025, there were 270 active drug shortages in the United States, according to the American Society of Health-System Pharmacists (ASHP). And while that number is down slightly from last year, the problem isn’t fading-it’s shifting.
What’s Actually in Shortage Right Now?
You might think shortages are random, but they’re not. Certain types of drugs are hit harder than others, and the list is long and growing. The most critical shortages are in sterile injectables, especially those used in hospitals. These aren’t over-the-counter pills-they’re life-saving treatments you can’t substitute easily.- 5% Dextrose Injection (small volume bags) - Shortage since February 2022, expected to last until August 2025. Used for hydration and delivering other drugs intravenously.
- 50% Dextrose Injection - Shortage since December 2021, expected to resolve in September 2025. Critical for treating low blood sugar emergencies.
- Cisplatin - A key chemotherapy drug for testicular, ovarian, and lung cancers. A 2022 FDA shutdown of an Indian manufacturing plant cut supply by half. Hospitals now ration it, giving priority to patients with the highest survival rates.
- Vancomycin and Cefazolin - Antibiotics used to treat serious infections. Shortages have forced doctors to use older, less effective alternatives.
- Levothyroxine - The most common thyroid medication. Demand has spiked 35% since 2020, and manufacturing delays have kept shelves bare in many areas.
- GLP-1 agonists (like semaglutide and liraglutide) - Used for weight loss and type 2 diabetes. Demand has exploded, and production can’t keep up. Many patients are being told to wait months for refills.
These aren’t obscure drugs. They’re the backbone of emergency rooms, cancer clinics, and primary care offices. When they’re gone, doctors scramble. Patients wait. Some get sicker.
Why Is This Happening?
It’s not one thing. It’s a chain of failures.Over 80% of the active ingredients in U.S. medications come from just two countries: India and China. That’s not a coincidence-it’s a cost-cutting strategy. Generic drug makers, who supply 90% of all prescriptions, operate on razor-thin margins-often 5% to 8% profit. Meanwhile, brand-name drugs make 30% to 40%. So when a factory in India has a quality control issue, or a port in China shuts down due to political tension, the system breaks.
And it’s not just about raw materials. The manufacturing process for sterile injectables is incredibly complex. A single contaminated batch can shut down a plant for months. In 2022, a single inspection failure at a facility producing half of the U.S.’s cisplatin caused a nationwide crisis that’s still being felt today.
On top of that, demand has surged. ADHD medications, weight loss drugs, and thyroid treatments are in higher demand than ever. But manufacturers didn’t scale up. Why? Because they can’t make money on them. The system rewards volume over resilience.
The FDA can’t fix this alone. They prevent about 200 potential shortages every year by stepping in early-but they have no power to force companies to produce more. No legal authority to require transparency. No ability to mandate stockpiles. They can only ask.
Who’s Getting Hurt?
It’s not just the hospitals. It’s the people.According to a 2024 AMA survey, 78% of physicians have delayed treatments because of drug shortages. Over 40% have had to switch patients to less effective or more toxic alternatives. In cancer care, 31% of patients experienced treatment delays averaging 14.7 days per interruption. That’s not just inconvenience-it’s risk.
Pharmacists are drowning. A 2025 ASHP survey found that 92% spend more than 10 hours a week just managing shortages. That’s 10 hours they’re not spending counseling patients, checking for interactions, or making sure the right dose gets to the right person. And 67% say they’ve made medication errors because of substitutions under pressure.
On Reddit, a pharmacist from Ohio shared how they had to ration cisplatin-only giving it to patients with testicular cancer, because that’s where survival rates are highest. Other cancers? They had to wait. Or try something less proven. That’s not medicine. That’s triage.
What’s Being Done?
There are some small wins. In early 2025, 63 shortages were resolved, mostly antibiotics. The FDA launched a new public reporting portal in January 2025-healthcare workers can now report shortages not yet on the official list. In three months, they received 1,247 reports, and 87% led to FDA action.Some states are stepping up. New York is building an online database that shows which pharmacies still have scarce drugs in stock. Hawaii now allows Medicaid to cover foreign-approved versions of drugs during shortages-something the FDA normally blocks.
But most hospitals still don’t keep a 30-day emergency stockpile. Only 28% do, because it’s expensive. And only 19 states let pharmacists switch medications without a doctor’s note-even when the original drug is completely gone.
Proposed tariffs on Chinese and Indian pharmaceutical ingredients could make things worse. If tariffs hit 50% to 200%, prices will rise, production may shrink further, and shortages could spike to over 350 by 2027.
What Can You Do?
If you’re on a medication that’s in short supply, here’s what to do:- Call your pharmacy ahead of time. Don’t assume they have it. Ask if they’re on allocation or if there’s a waitlist.
- Ask your doctor about alternatives. Not all substitutes are equal, but some are safe and effective. For example, if you’re on 5% dextrose, oral hydration may be an option.
- Don’t stop your medication. Even if you have to wait a few days, stopping suddenly can be dangerous-especially with thyroid, seizure, or heart meds.
- Check the ASHP Drug Shortages Database. It’s updated weekly and lists active shortages, expected resolution dates, and alternatives.
- Join patient advocacy groups. Organizations like Patients for Affordable Drugs are pushing for policy changes. Your voice matters.
There’s no quick fix. The system is broken because it’s built on cheapness, not reliability. But awareness is growing. More doctors are speaking up. More pharmacists are demanding change. And more patients are asking questions.
If you need a drug today and it’s not available, you’re not alone. But you’re not powerless either.
Why are generic drugs more likely to be in shortage than brand-name drugs?
Generic drugs make up 90% of prescriptions but only 20% of pharmaceutical revenue. Manufacturers make very low profits-often just 5% to 8%-so they can’t afford to keep extra inventory or invest in backup suppliers. Brand-name drugs, with profit margins of 30% to 40%, can absorb cost increases and maintain multiple production lines. When a factory shuts down, generics have no financial cushion to fall back on.
Can I get a substitute if my medication is out of stock?
It depends on your state and the drug. In 47 states, pharmacists can substitute a therapeutically equivalent generic. But only 19 states allow substitutions without a new prescription. For high-risk drugs like chemotherapy, insulin, or seizure meds, substitutions are rare and tightly controlled. Always check with your doctor before switching.
How long do drug shortages usually last?
It varies. Some resolve in weeks; others last years. The average shortage lasts 12 to 18 months. But many of today’s shortages started in 2022 or earlier and are still active. The most persistent ones are sterile injectables and chemotherapy drugs, where manufacturing is complex and supply chains are fragile.
Is the FDA doing enough to prevent drug shortages?
The FDA prevents about 200 potential shortages each year by intervening early-but they can’t force companies to produce more. They can’t require transparency, mandate stockpiles, or stop manufacturers from leaving the market. Their power is limited to monitoring, warning, and negotiating. Without new laws giving them authority to act, shortages will keep happening.
Are there any new drugs being developed to replace the ones in shortage?
Not for most of the critical shortages. Drugs like cisplatin, saline solutions, and vancomycin are decades old. They’re cheap, well-understood, and hard to replace. New drugs are expensive to develop and approved for new conditions-not to fill gaps in old ones. The focus isn’t on innovation-it’s on keeping the old system running.
Should I stockpile my medications if I’m worried about shortages?
No. Stockpiling can make shortages worse by creating artificial demand. It’s also unsafe-medications expire, and dosages can change. Instead, work with your doctor to have a backup plan. If your drug is on the shortage list, ask about alternatives now, before you run out.
What’s Next?
The U.S. Pharmacopeia says three things must happen: financial incentives for domestic manufacturing, mandatory strategic stockpiles for critical drugs, and a national early warning system that connects manufacturers, distributors, and hospitals in real time.Without those changes, shortages won’t disappear. They’ll just get worse.
For now, the best defense is awareness. Know which drugs are in short supply. Talk to your pharmacist. Ask your doctor about alternatives. And don’t stay silent-if you’ve been affected, speak up. This crisis won’t fix itself. But it can be fixed-if enough people demand it.