For a patient with anxiety and a history of depression, conditions that often overlap, “you may want to avoid a benzo because they can also be depressants, and buspirone can be a safer, more reasonable option,” he said.
Patients also do not have the choice of paying more to buy the brand-name version of buspirone, Buspar, because it is no longer made.
Buspirone prescriptions dispensed in the United States rose to 13.5 million in 2017 from 10.2 million in 2015, with the number estimated to reach nearly 15 million last year, according to IQVIA, a health care technology and data analytics provider. The reasons for the increase are unclear, though the opioid epidemic may have made some physicians more reluctant to prescribe highly addictive anti-anxiety medications that can be lethal when combined with opioids.
The main reason for the buspirone shortage appears to be interrupted production at a Mylan Pharmaceuticals plant in Morgantown, W.Va., which produced about a third of the country’s supply of the drug. The Food and Drug Administration had said the facility was dirty and that the company failed to follow quality control procedures.
Mylan has told the F.D.A. the date for resuming buspirone production is “T.B.D.”
“Companies don’t have to tell the F.D.A. how long the shortage is going to last or when they expect it to be back,” making planning difficult for doctors and patients to manage, said Erin Fox, senior pharmacy director at University of Utah Health and director of its Drug Information and Support Services.
Most drug manufacturing plants are already running at full capacity so “when one shuts down even for a short period of time, there is no resiliency in the supply chain for anyone else to make up the difference,” Dr. Fox said.
Rock bottom prices for some generic drugs are also contributing to the crisis. Consolidation among wholesalers has led to the creation of three buying consortium behemoths that purchase 90 percent of the generic pharmaceutical products in the United States, said Adam Fein, a consultant and chief executive of Drug Channels Institute. These “monster” buyers have squeezed manufacturers on prices, and “some of those generic manufacturers are deciding the profit is so low they can’t make money, and they’re exiting the category,” Dr. Fein said.
At least one relatively small buspirone manufacturer, Impax, has left the market.
“Drugs like buspirone are not considered critical or lifesaving drugs by the F.D.A.,” said Dr. Beth Salcedo, president of the Anxiety and Depression Association of America. “But the reality is that when you look at anxiety and depression, we lose a lot of people every year to these illnesses.”