Story 19 Fentanyl — and the Sandoz closure

A family practitioner writes….
Sandoz shortage has been a huge problem.  I heard from my friend in [small town in SW Ontario] that their hospital has run out of Fentanyl.  Now women who would have labored easily with IV PCA Fentanyl have to have an epidural, which increases risks of vacuum and forceps deliveries.  She is describing how frustrating this is and that labor has become much longer.
Also, small town hospitals are finding the drug shortage an issue (another friend in small town in N Ontario) was telling me that the bigger hospitals are hoarding medications and the smaller hospitals with smaller budgets are now regularly out of stock.
Fentanyl is a good example because at [my big city hospital] it is still easily available. In fact, [a palliative care doctor] has started a palliative symptom-control project where kits with fentanyl and Stemetil (and other palliative meds) go to palliative patients homes for possible future use.  This is really not appropriate as they will be taking meds that are in short supply for possible use in the future.
The issue is that there is no global oversight and coordination of pharmaceutical supply and demand that can control overuse, waste, hoarding etc… Given that pharma is a significant portion of health care costs, this is ridiculous!