| Black widow spiders loom in the popular imagination, with their signature red hourglass markings and reputation for dangerous bites. While rarely fatal — US poison centers recorded about 1,000 bites in 2021, and no deaths — they are incredibly painful. "People can't describe it very well, but they're writhing in agony on their bed in the emergency department," says Richard Dart, a poison expert who runs Rocky Mountain Poison & Drug Safety, part of the Denver Health system. "And I mean writhing in agony." There's an antivenom that can drastically relieve the pain. But the medicine — like over 300 other drugs in the US — is in short supply. The reasons for the shortage — and the potential solutions — are illustrative of how drugmakers and hospitals might alleviate supply crunches of other medicines. Supply constraints have been ongoing since 2009, according to the University of Utah's drug information service, which tracks shortages. Dart chalks it up to two reasons — manufacturing hurdles and issues with hospital stocking. Black widow antivenom is made by injecting horses with the venom, letting them develop antibodies, and then collecting the antibodies from the horse's blood. Sometimes, Dart says, the drug's manufacturer, Merck & Co Inc., "runs out of supply before another 'batch' can be harvested and processed." Merck declined to comment on this characterization. Dart has done trials of a new black widow antivenom developed by a different company, which he hopes will be more widely available. Dart says it doesn't make sense to produce too much antivenom because it isn't frequently used and can quickly expire. Merck sells 300 to 800 vials a year on average, a company spokesperson says. Merck is working with the US Food and Drug Administration to extend the expiration date and increase the available supply; the FDA recently lengthened the date by two years for some lots. Merck says lots will be available in the coming months that have five-year expiration dates. To reduce shortages in general, the FDA has asked Congress for more authority to require companies to lengthen expiration dates. Dart also says that hospitals don't always stock the drug since it's used so rarely — it might expire on the shelf and then the hospital can't bill anyone for the treatment. He says his poison center gets calls all the time from hospitals looking for the drug. Without the black widow antivenom, there isn't much you can do to ease the pain of a bite, Dart says. He'll usually give patients benzodiazepines to put them to sleep so that they're unconscious while their bodies are suffering. "Take a nap, you're going to be miserable for 12 to 24 hours, but tomorrow you will feel better," he said. And when a patient is able to get the antivenom, it's an immense relief. He recalled one patient, who, 20 minutes after receiving the drug, "literally got down on the floor on his knees and thanked me," Dart says. "It's a very dramatic effect." — Ike Swetlitz | 
No comments:
Post a Comment