Drug shortages continue to dog doctors, patients and parents in Michigan and throughout the country, with deepening shortages in drugs that range from antibiotics for ear infections and strep throats, to penicillin to treat syphilis and two critical cancer drugs.

In Ann Arbor, the latest challenge for Dr. Stephanie Goodson, a pediatrician, has been finding medicines to treat her young patients’ attention deficit hyperactivity disorder (ADHD).

The U.S. Food and Drug Administration announced a shortage of Adderall in October, and supplies have fluctuated since then. But Goodson said her staff in recent weeks has spent much of their days calling pharmacies to track down Adderall, or alternatives, for patients.

“It’s not unusual for us to get a phone call that ‘My child still doesn’t have their medication and it’s been a week,’” said Goodson, who works at C.S. Mott Children’s Hospital. “And we’re calling the pharmacy that tells us it has been ordered, but they still don’t have it.”

Nationally, 136 drugs were in short supply as of Friday, according to the FDA list of short-supply drugs.

But the list is an oversimplified look at a more complex reality that can vary from region to region and be complicated by several factors, said Tom Cotter, executive director of Healthcare Ready, a Washington-based research organization that tracks supply chain issues.

In fact, the American Society of Hospital Pharmacists lists 47 new shortages just in the first quarter of 2023. Drugs that continue to be limited from previous quarters add to the list, bringing the total to 301 drug supply shortages — the most since 2014, according to the pharmacists group.

Drug shortages are not so much a problem with a linear “supply chain,” Cotter said. It’s a more complicated “supply web.” Shortages might be regional and “not felt the same way in New York City as they are in Navajo Nation in Arizona,” he said.

And Michigan is feeling the pinch.

“We deal with supply chain issues on a daily basis, but the pace at which it’s occurring is certainly escalating,” said Eric Warren, clinical coordinator at the Munson Healthcare pharmacy in Traverse City.

Among perhaps the most critical drug shortages are two chemotherapy drugs, cisplatin and carboplatin used to treat several types of cancer, Warren said. That includes bladder, breast and ovarian cancers.

The drugs work by sticking to the cancerous cells and preventing their division into new cells and, according to Warren “they are extremely limited and almost entirely gone.”

Disease outbreaks are often the drivers of shortages.

There was a sudden spike in demand for antifungal medications, for example, in recent months in the middle of Michigan’s Upper Peninsula, when more than 100 papermill workers were infected with the fungus blastomyces, according to health officer Mike Snyder of Public Health Delta & Menominee Counties.

With a rise in the nation’s rates of syphilis, there’s also a shortage of a form of penicillin, considered the gold-standard care for syphilis.

Earlier this month, the Michigan Department of Health and Human Services asked public health departments to prioritize penicillin for pregnant women, for example. The department usually has up to 200 doses on hand; now it has fewer than 100, said department spokesperson Chelsea Wuth.

And last year’s “tripledemic” of RSV, COVID and flu triggered ear and bacterial infections that drove up demand for antibiotics, Cotter said. (Antibiotics don’t treat the original viral infections, but related bacterial infections.)

It takes time for Big Pharma to shift gears from one production to another and ramp up quickly enough to meet immediate demand, Cotter said: “This is a big complex machine that does not turn very quickly.”

At the same time the nation’s youngsters were filling emergency rooms with coughs and stuffy noses and more serious symptoms from the outbreak of respiratory illnesses, he suspects sick children’s parents who heard of drug shortages may have started stockpiling cold meds and painkillers formulated for children, like children’s ibuprofen, Cotter said.

If that’s the case — and FDA commissioner Robert Califf in December urged parents not do so — it’s not that he blames them.

“If you look at a place that is three days out from having a hurricane make landfall, all of the gas cans disappear from the shelves,” he said. “And that’s not because there’s a shortage of gas. It’s because the demand spiked.

“If you have a sick kid and you don’t know how long it’s gonna last, it’s very hard for me to place the blame on a parent who pays to make sure they have access to the things they need to keep their children or themselves healthy,”

In some cases, a manufacturing process has been disrupted because of business decisions.

Akorn Pharmaceutical, which settled federal allegations last year of Medicare fraud, closed abruptly earlier this year. It manufactured a very specific formulation of albuterol, one of the short-supply drugs now listed by the FDA. The drug opens up airways, makes it easier to cough and eliminates mucus.

“When someone leaves the marketplace, it takes a while for these gaps to fill,” said Munson’s Warren.

Also contributing to the problem from time to time are reasons more difficult to track: shortages in warehouse space or transportation strikes, Cotter said.

Whatever the reason, it means patients may more often face limits on the drugs they can get. A 30-day supply, for example, may be reduced to three days, Warren said.

And as doctors seeking medication for their patients — whether it’s to treat ADHD or strep throat — must work their way down their list of alternatives, the shortages of one drug “cascades” into others, said Mott’s Goodson.

When diagnoses for ADHD climbed during the pandemic, so, too, did the demand for Adderall and eventually what doctors turned to as an alternative, Concerta. Now that’s tougher to find, too, Goodson said.