With intravenous fluid units in short supply, the use of on-demand IVs in hangover-cure businesses and spas create an ethical dilemma.
Sarah C. B. Guthrie
You’ve seen movies about long nights of Las Vegas-style partying. Have you heard of the new cure? Just go to your local hangover cure bus, receive a vitamin cocktail intravenously, and – poof – your hangover is gone and you can get back to partying. What could possibly go wrong?
Plenty, it turns out.
This rising wave of so-called “hangover cure” businesses opening in Las Vegas, New York, LA, and South Florida offer vitamin and drug “cocktails” that are delivered intravenously. But there are unanswered questions about this new industry's risk and its impact.
The U.S. is in an IV supply crisis. The Food and Drug Administration (FDA) regulates intravenous vitamins, electrolyte, and nutritional products as drugs, unlike over the counter vitamins and supplements.
Over the past year, there have been numerous stories about drug shortages, including heart-breaking stories of premature babies needing IV's of multivitamins, zinc and phosphorus to live. But even after a year of reporting, the problem persists and now it’s not just micronutrients in short supply.
Basic ingredients such as the sterile water required to compound IV medications, electrolytes and saline solution are in short supply.
“The public needs to be aware that these ‘hangover cures’ may come at the expense of patients who need them to survive, including infants and others who physically cannot eat, or patients with cancer and other gastrointestinal illnesses who cannot digest food,” cautioned Dr. Lingtak-Neander Chan of University of Washington’s School of Pharmacy.
The problem, according to Chan, lies in a complex web of manufacturing problems, FDA regulations and increased demands in the general consumer market for these IV products. It’s a case where the usual economic laws of supply and demand do not pan out.
“Making saline solution or potassium is not a very profitable business,” said Chan. “If there are only two U.S. FDA-approved manufacturers making medical-grade saline – and one of them shuts down – you suddenly have a nationwide shortage. Without additional incentives, companies are not motivated to make products that have low profit margins.”
The drug shortage is unique to the United States and developing countries. “Europeans and our neighbors in Canada and Mexico don’t have this problem,” Chan said. In fact, the FDA temporarily lifted an embargo on importing drugs to meet urgent U.S. demand. Drugs from other countries normally must go through a complex approval processes to be sold in the United States, even if they have a history of safety and effectiveness.
With IV fluid and micronutrient shortages, where are the hangover cure businesses getting their IV ingredients?
“We don’t know,” Chan said. “If U.S. hospitals are scrambling to get the supplies they need to save patients’ lives, where are these hangover businesses getting their products from? As a consumer, how do you know that IV fluid is safe? How do you know if the vitamins and drugs were compounded in a sterile environment? How do you know it’s not just a placebo?”
Many of these businesses are expanding beyond hangovers and marketing treatments to patients with cancer and other serious illnesses. “My concern is that theses patients are going to these businesses to get care they should be able to get through their doctor, hospital, or clinic,” Chan added.
Additionally, some of the hangover cocktails include drugs that are questionable or dangerous. Commonly cited ingredients include glutathione, which has not been clinically proven to be effective, and prescription drugs that can have side effects such as kidney failure or gastric bleeding – far worse than riding out a hangover.
Chan recommends people think through the possible consequences of an elective IV. He urges health professionals to document and publish their experiences with micronutrients and the impact of the shortages. Shortages of vitamins and saline might not get the media attention of an ebola outbreak, but they affect more people because the therapies are used for so many conditions.
There’s no question that when faced with a raging headache and nausea, we all want relief fast. But with the reality of nutrient and IV solution shortages coupled with multiple questions about safety, perhaps it’s best to drink water, get a cold compress and go back to bed.