For Clinicians | Why Drug Shortages Happen and How Long They Actually Last

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed and edited by Kristen Carpenter, PA-C

Hi, I’m Jamie. I’m also a pharmacist. I’ve spent more than ten years behind the pharmacy counter, and I’ve helped thousands of patients and prescribers work around a drug shortage. Unfortunately, I know a lot about drug shortages and what a pain they can be. 

Drug shortages peaked in 2024, when 323 of them were active at once. We’re lower now, but 227 drugs are still in shortage as of mid-2026.¹ So I thought it would be fun to do this one question-and-answer style: what a shortage actually is, why they happen, what your pharmacist can and can’t do, and what you should know as a prescriber to help your patient through one.

These are the questions I get the most, and my answers.

“Why do drug shortages keep happening?”

Most of the time nobody tells us. When the University of Utah Drug Information Service asked manufacturers why a drug went short in 2025, 59% either didn’t know or wouldn’t say.¹ Independent analysis fills in some of that gap and points to manufacturing quality problems as the largest single driver.² A problem turns up at a plant, the manufacturer slows or halts production to fix it, and supply that was already thin disappears. Just under half of this year’s new shortages came from sole-source products, where one manufacturer is the whole supply.¹Most of the drugs that go short are generic sterile injectables, hard to make and sold for almost nothing because hospitals buy on price.³

Which explains why a shortage doesn’t ease just because the whole country needs the drug. In most markets, high demand pulls in new suppliers. Here in the pharmacy manufacturing world it barely does. A company that wanted to start making a short drug needs its own FDA approval for that product at that specific plant, plus tech transfer and validation batches on a sterile line. That’s a multi-year project ending in a product that sells for pennies, and the shortage may be over before they arrive. So nobody comes and medication stays short sometimes for whole years.

The drug comes back when that manufacturer fixes what the FDA found, revalidates the line, and passes reinspection. That clock runs on remediation, not on how badly your patient needs it.

“How long do drug shortages last?”

Way too long. HHS looked at every shortage between 2018 and 2023 and found a median duration of 2.55 years.⁴ Not weeks or months that you’d mentally expect. Years.

The split by dosage form is important here for you healthcare providers. Oral drugs ran a median of 1.59 years, injectables 4.60.⁴ Three years into a shortage, 8.1% of oral products were still short. For injectables it was 64.6%.⁴ So if what your patient needs is a tablet, waiting it out is at least a real strategy. If it’s an injectable, the odds are close to two in three that it’s still short three years from now.

“So what does this mean for your patients?”

Here’s the weird part: a drug in shortage is usually not 100% unavailable. Shortage means supply isn’t meeting demand, and day to day that looks like dribs and drabs are coming into the pharmacy. Some weeks the wholesaler releases a little, some weeks nothing. One strength ships while another doesn’t. Most of the time the drug goes on allocation, so a pharmacy can order only a fraction of what it normally buys, based on its own purchase history.

Which is why two pharmacies in the same town tell your patient different things in the same week, and both are being truthful for their situation. One got a partial shipment Tuesday. The other is capped well below what it needs and spent its allocation on patients already established on the drug.

So when a pharmacy says they can’t get it, that’s true, and it’s also not the whole story. It’s this pharmacy, this week, this strength.

“But the FDA site says there’s no shortage…”

Great question. And it is confusing here! Two national lists intentionally count different things. FDA calls it a shortage when nationwide supply isn’t meeting current or projected demand. ASHP lists any shortage a practitioner reports and it confirms, down to the specific manufacturer, strength, and vial size.7 So a drug can be truly unavailable from the manufacturer your patient’s pharmacy buys from and never show up on FDA’s list, because nationally the supply is holding.

Same reason this year’s headline numbers look like they contradict each other. Only 89 new shortages started in 2025, the fewest since 2006.⁵ Active shortages climbed anyway, three quarters in a row.⁶ Fewer beginnings, yes, but the existing backlog isn’t clearing.

So when your patient says the FDA site shows their drug isn’t short, they aren’t wrong. They’re reading the answer to a different question.

“What can the pharmacy actually do?”

Most of this is our job as pharmacists and pharmacy technicians, and it starts before we call you. We’re checking what the wholesaler will release, calling nearby locations, pulling the manufacturer’s estimated resupply date, and working out which substitution is actually available today. By the time your phone rings, we’ve usually ruled out the easy options and we’re calling because the remaining one needs your signature.

Here’s what we’re working through behind the scenes:

• Another manufacturer. For a generic we can usually source a different labeler without calling you at all, unless you wrote it brand-specific or dispense as written.
• Another strength at the same total dose. Two 10 mg tablets instead of one 20 mg. Depending on your state, we can often do this without a new prescription.
• Another formulation. A capsule substituted for a tablet, etc. Requires a new Rx from you.
• A transfer (as long as it hasn’t been filled yet). Since 2023, even controlled substances can move. An electronic prescription for a Schedule II through V drug can transfer between retail pharmacies one time, at the patient’s request, pharmacist to pharmacist, where state law allows.⁸

One caution on the resupply date we quote you. It comes from the manufacturer and it moves. Treat it as an estimate with the best information we get…. not a promised delivery date.

“How do I work with the pharmacy most efficiently on this?”

Your pharmacist will probably reach out with a substitution already in mind, or handle it without you when we’re able to. That’s going to be more effective than sending over a best guess that may well be out of stock too.

Controlled substances are where the order of operations flips. A Schedule II prescription can’t be refilled, so every fill is a new prescription, and you can’t scatter one across three pharmacies to see who has stock. ADHD stimulants are the poster-child drug classes most of us have lived through recently.⁵ So have your patient call around first and confirm the exact drug, strength, and quantity is physically on the shelf of a pharmacy, then send the prescription to that pharmacy. Some won’t confirm controlled stock over the phone, so your patient may have to walk in and ask. Either way it beats your staff calling every pharmacy in the county. And if a prescription is already sitting at the first pharmacy, ask them to delete it so you don’t leave a duplicate out there.

The bottom line

Shortage guidance exists, but look who it’s written for. ASHP’s is built for a P&T committee, FDA’s for manufacturers. Neither one tells you what to do about one patient, one prescription, and one pharmacy that got a partial shipment Tuesday with a waitlist a mile long.

Shortages have stopped being interruptions. They’re part of the job now. The prescribers who handle them well decided how they would handle them before the call came in. That outpatient gap is where we work. Appropriate medical preparation is our name for it: a licensed provider reviews the request and writes the prescription ahead of the moment a patient needs it, for a short list of common conditions. It complements primary care, it doesn’t replace it.

If your patients are asking questions you don’t have time for, send them to us at Jase.com. We’d rather help you plan for the next shortage than help your patient recover from the last one.

Sources

1. National Drug Shortages, January 2001 to June 2026. American Society of Health-System Pharmacists, data from the University of Utah Drug Information Service. 227 active shortages as of Q2 2026, up for a third consecutive quarter, against an all-time high of 323 in the first quarter of 2024; 89 new shortages in 2025; 16% of active shortages are controlled substances; 48% of new 2026 shortages are sole-source; manufacturers reported no reason or an unknown reason for 59% of 2025 shortages. https://www.ashp.org/drug-shortages/shortage-resources/drug-shortages-statistics 
2. Wosińska ME. Drug shortages: a guide to policy solutions. Brookings Institution, March 13, 2024. Manufacturing quality disruptions the leading cause of shortages, 46% in 2022; generic sterile injectables 63% of current shortages. https://www.brookings.edu/articles/drug-shortages-a-guide-to-policy-solutions/ 
3. McGeeney JD, McAden E, Sertkaya A. Analysis of Drug Shortages, 2018-2023, Introduction. Data brief prepared for HHS ASPE Office of Science and Data Policy, January 8, 2025. Purchasers have limited ability to assess manufacturers’ quality systems or backup capacity and often choose drugs solely on price, rewarding companies that reach lower costs by sacrificing investment in resilient manufacturing; facilities typically run above 80% capacity, so firms cannot easily increase production during a shortage. https://aspe.hhs.gov/reports/drug-shortages-2018-2023 
4. McGeeney JD, McAden E, Sertkaya A. Analysis of Drug Shortages, 2018-2023, Results. Median shortage duration 2.55 years overall, 1.59 years oral, 4.60 years injectable. Three years after onset, 64.6% of injectable shortages remained unresolved, against 8.1% of orals and 26.1% of topicals. https://aspe.hhs.gov/reports/drug-shortages-2018-2023 
5. Silverman E. The number of new drug shortages in the U.S. hits lowest level in 20 years, but myriad problems remain. STAT News, January 22, 2026, reporting ASHP’s year-end 2025 data. 89 new shortages in 2025, the fewest since 2006; ADHD medications and controlled substances remain difficult to source. https://www.statnews.com/pharmalot/2026/01/22/medicines-pharma-biotech-shortages-hospitals-injectables/ 
6. Active US drug shortages rise for third straight quarter. AJMC. 227 active shortages as of the second quarter of 2026. https://www.ajmc.com/view/active-us-drug-shortages-rise-for-third-straight-quarter
7. FDA vs. ASHP Drug Shortages List. American Society of Health-System Pharmacists. ASHP confirms practitioner-reported shortages at the manufacturer, strength, and fill-volume level; FDA assesses shortages against nationwide supply and demand. https://www.ashp.org/-/media/assets/drug-shortages/docs/drug-shortages-fda-vs-ashp-shortage-list.pdf 
8. Transfer of Electronic Prescriptions for Schedules II-V Controlled Substances Between Pharmacies for Initial Filling. Drug Enforcement Administration final rule, 88 Fed. Reg. 48365 (July 27, 2023), effective August 28, 2023; Docket No. DEA-637, RIN 1117-AB64. One-time transfer for initial filling at the patient’s request, communicated directly between two licensed pharmacists, prescription unaltered and in electronic form, permissible only where state law allows. https://www.federalregister.gov/documents/2023/07/27/2023-15847/transfer-of-electronic-prescriptions-for-schedules-ii-v-controlled-substances-between-pharmacies-for

For Clinicians | Psychiatric Medications in a Disaster

Why Stopping and Restarting Are Two Different Hazards

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed and edited by Kristen Carpenter, PA-C

Our last article ranked a patient’s Rx medicine cabinet so you could tell a patient which of their prescriptions genuinely can’t wait and are the most important. One row on that table needed a lot more room than we gave it. Disaster planning almost always lands on insulin and blood pressure medication, and that’s not anybody’s oversight. It’s where the evacuee data pointed, so it’s where the guidance went. We went looking for mental health medications on the standard kit lists and came up empty.

So this write up is only about mental health medications. Stopping them is one hazard and restarting them is a separate one. We’re covering two specific drugs, clozapine and lithium, and one whole class, the benzodiazepines, because all three fail in a different direction when access is disrupted with the rules of thumb that hold across the category.

Clozapine: the number of days decides the dose

When a patient on clozapine has had any gap in dosing, the first thing to establish is the date of the last dose.¹ The length of the gap is what sets the restart dose. Their maintenance dose is not the default answer.

The mechanism is loss of tolerance to clozapine’s hypotensive effect.² Current labeling puts orthostatic hypotension, bradycardia, syncope and cardiac arrest among the things that can happen “when restarting patients who have had even a brief interruption in treatment,” at doses as low as 12.5 mg a day.² The same labeling names dehydration as a predisposing condition, which is the state a lot of these patients are in during a natural disaster.

US labeling sets the restart by days missed:²

• One day missed: resume at 40% to 50% of the previous dose
• Two days missed: resume at roughly 25% of the previous dose
• Anything longer: restart at 12.5 mg once or twice daily, then climb back faster than a new start

Clozapine can drive down neutrophils, the white cells that fight bacterial infection, so these patients have to get regular blood draws to check the absolute neutrophil count (ANC). If that count falls far enough, an ordinary infection can turn life-threatening. A break under 30 days doesn’t change the ANC monitoring schedule. At 30 days or more, monitoring reverts to the weekly-for-six-months schedule of a new start.² A one-week outage changes the dose and leaves the bloodwork alone. Until February 2025, the Clozapine REMS made a pharmacy verify an ANC before dispensing, so the monthly refill didn’t go out without a current lab value on file, and a patient who had drifted out of monitoring hit a hard stop at the counter.³ That backstop is gone, so the extra eye on a clozapine patient has to be yours now.

Benzodiazepines: write the plan down while you still can

For any patient on a daily benzodiazepine, the contingency plan needs to be documented while they can still reach you. Labeling is really clear and tells us why: abrupt discontinuation or rapid dose reduction after continued use “may precipitate acute withdrawal reactions, which can be life-threatening,” seizures among them.⁴ The 2025 joint tapering guideline, ten societies including ASAM and the APA, says anyone past a month of use shouldn’t stop abruptly and should taper under supervision.⁵

Withdrawal symptoms start 2 to 10 days after the last dose and can run for weeks.⁶ This is exactly why it is important to have a plan ahead of time for these medications. Withdrawal in this class needs active treatment, and a disaster is when active treatment is hardest to reach.⁶ A patient in withdrawal during an evacuation is agitated, tremulous, and tachycardic, in a setting with nothing to manage it with. 

Controlled-substance prescribing follows the same federal and state rules during a declared emergency so there isn’t disaster wiggle room here. The built-in emergency provisions are narrow, and some states bar writing for a patient the provider hasn’t examined unless that rule gets waived.⁷ 

The biggest reason patients lose access to key medications like this is structural. That means no money, no services running, or no way to get there. After Katrina, that was the reason for 74% to 84% of the people who were already in mental health treatment and then cut back or stopped.⁸ So these are the patients whose plan you prioritize. Getting through a natural disaster on a stable regimen is hard enough. Doing it in withdrawal is worse, and that’s the part planning ahead can actually change.

Lithium: the risk shows up without a missed dose

The conversation for a lithium patient is particularly interesting because in a disaster it isn’t about the medication itself that we have to worry about so much. It’s more about what the patient taking lithium is exposed to: heat, fluids, salt, and what pain medication they are using.

The kidney handles lithium a lot like sodium, so sodium or volume depletion drives reabsorption up and excretion down.⁹ Serum levels climb on an unchanged dose. Dehydration, vomiting, diarrhea, fever, and a low-sodium intake all contribute. So does a week of heat with no air conditioning, which is how a power outage affects a lithium level.

Then there’s the part that comes from the medicine cabinet instead of the weather. NSAIDs and ACE inhibitors both raise lithium levels by changing how the kidney handles sodium.⁹ A patient with a sprained ankle and a bottle of ibuprofen in a house with no power has assembled a lithium problem out of ordinary decisions.

The counseling point is early toxicity: a new tremor, GI upset, feeling unsteady.⁹ Those are vauge-ish symptoms that a patient may very well shake off as just being part of living through a natural disaster and miss them as warning signs. If these warning signs manifest then that’s a call to the prescriber, not a dose the patient adjusts on their own.

Everything else on the list

Clozapine, benzodiazepines, and lithium are the high-alert three. Most of your patients are on something else and the risk on those is different. A gap produces withdrawal symptoms, and over a longer stretch relapse, rather than the acute physiologic events the first three carry.

Two things predict how hard your patients will be hit. The first is half-life, which is just how long the drug is still doing its job after the last dose. Nobody has these memorized, and looking one up takes awhile, so here they are.¹⁰

The second is how long they’ve been on it. Someone a few weeks into an SSRI is at low risk of serious withdrawal. Someone eight years in certainly is at a much, much higher risk of withdrawal.¹¹

Half-life is a first pass, not a verdict. Sertraline’s half-life sits above paroxetine’s, and it made almost no difference: after 5 to 8 days off, withdrawal showed up in 60% of patients taking sertraline and 66% on paroxetine, against 14% on fluoxetine.¹² The table sorts the extremes reliably. In the middle it’s a rough guide.

Oral antipsychotics and mood stabilizers don’t sort this way. Their gap risk is relapse over weeks to months rather than withdrawal over days, so half-life doesn’t predict it.

Restarting is simpler here than with clozapine. Nothing has lost tolerance, so a short gap generally resumes at the prior dose. A long one doesn’t. Reinstating a drug months after stopping it can behave unpredictably, including symptoms worsening rather than settling.¹¹

One thing not to counsel: stretching the interval. Spacing doses to every other day is the intuitive way to make what’s left go further, and for most of this list it’s the wrong move. Because so many of these half-lives run under a day, every-second-day dosing swings concentrations up and down and can precipitate severe withdrawal, which is the outcome the patient was trying to avoid.¹¹ If someone is going to run short, the prescriber reduces the dose rather than widening the interval.

Two halves of preparation

We want patients protected in a disaster, and the ones on mental health medications have been left out of many disaster preparation conversations.

Appropriate medical preparation here comes in two halves. The first is clinical, and it’s the whole article above: knowing which of your patients has no buffer, knowing that the restart is a prescriber decision rather than the patient’s, and having that decision on paper before anything happens. That first half is not a quantity, and for this class it can’t be, since controlled substances like benzodiazepines have so much red tape around dispensing them.

The second half is boring, and it’s the one that gets skipped. The formal, active, updated medication list that travels with the patient. In one Japanese flood study, 48% of evacuees left their medication behind and 88% left their prescription records behind.¹³ People remember the pills more reliably than the paper, and the paper is what lets any pharmacist or any prescriber anywhere pick up the thread.

None of this replaces primary care. It’s the layer that helps prepare a patient well with your help ahead of if/when primary care isn’t reachable.

Jase Daily: extends the list, not the benzodiazepines

Jase Daily extends a stable, existing prescription up to a 12-month supply for a patient your practice has seen within the past 6 months. That covers lithium and most of the SSRIs and SNRIs above. It doesn’t cover benzodiazepines. Jase’s pharmacy doesn’t dispense controlled substances, so a benzodiazepine patient’s continuity still runs through the written plan, not a supply workaround.

Sources

1. ACLP How To Guide: Clozapine Consultation. Academy of Consultation-Liaison Psychiatry, 2024. Directs clinicians to determine the patient’s last clozapine dose as soon as possible, and gives a re-initiation schedule that differs from US labeling: no re-titration up to 48 hours, half the previous total daily dose then 75% then full dose over three days for a 48 to 72 hour break, 12.5 mg once or twice daily from 72 hours to one week, and titration as a new patient beyond a week. http://clpsychiatry.org/wp-content/uploads/ACLP-How-To-Guide-Clozapine-2025.pdf 
2. Clozaril (clozapine). FDA prescribing information, revised June 2025. Identical language across Clozaril, clozapine tablets, and clozapine orally disintegrating tablets. Warnings state that orthostatic hypotension, bradycardia, syncope, and cardiac arrest have occurred, and that these reactions can occur with the first dose, at doses as low as 12.5 mg per day, or when restarting patients who have had even a brief interruption in treatment; dehydration is named among predisposing conditions. Section 2.6 sets the restart at 40% to 50% of the previous dosage after one missed day, roughly 25% after two, and 12.5 mg once or twice daily for longer gaps. ANC testing continues at the previous frequency for interruptions under 30 days and reverts to the initiating-treatment schedule, weekly for months 1 through 6, at 30 days or more. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=90876802-0e3a-44c9-9ff7-1754dfbe736a 
3. Clozapine REMS has ended. National Community Pharmacists Association, 2025. The program ended effective February 24, 2025; pharmacies no longer need ANC results before dispensing, and FDA continues to recommend prescribers monitor ANC at labeled frequencies. The current labeling contains no REMS references while retaining the ANC monitoring table. https://ncpa.org/newsroom/qam/2025/03/31/clozapine-rems-has-ended 
4. Xanax (alprazolam). FDA prescribing information, revised April 2024. Boxed Warning states that continued use may lead to clinically significant physical dependence, and that abrupt discontinuation or rapid dosage reduction after continued use may precipitate acute withdrawal reactions, which can be life-threatening; section 5.3 names seizures as an example. Dependence risk is greater above 4 mg daily and beyond 12 weeks but exists after shorter use at lower doses. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bb5cf72e-3a41-41a8-9a38-80f974eca33f 
5. Brunner E, et al. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits. Journal of General Internal Medicine, 2025;40(12):2814-2859. Sponsored by ten organizations including ASAM, the AAFP, and the APA. Patients taking benzodiazepines longer than a month should not abruptly discontinue and should taper under clinical supervision. https://www.asam.org/quality-care/clinical-guidelines/benzodiazepine-tapering 
6. Regina AC, Gokarakonda SB, Attia FN. Withdrawal Syndromes. StatPearls, NCBI Bookshelf. Benzodiazepine withdrawal develops 2 to 10 days after discontinuation and can last weeks; seizures are named among the physical signs; benzodiazepine and barbiturate withdrawal are described as potentially life-threatening and requiring aggressive management. https://www.ncbi.nlm.nih.gov/books/NBK459239/ 
7. Rutkow L, et al. Prescribing authority during emergencies: challenges for mental health care providers. Journal of Legal Medicine, 2011. Providers must follow the federal and state laws regulating prescribing during an emergency, the emergency provisions in those laws are limited, and some states do not permit prescribing for a patient the provider has not examined unless that provision is waived during a declared emergency. https://pmc.ncbi.nlm.nih.gov/articles/PMC3229266/ 
8. Wang PS, et al. Disruption of existing mental health treatments and failure to initiate new treatments after Hurricane Katrina. American Journal of Psychiatry, 2008;165(1):34-41. Among survivors with a pre-hurricane mental disorder, 12.7% terminated and 10.2% reduced treatment, 22.9% combined. Barriers involving enabling factors, meaning financial barriers and unavailability of services plus transportation problems outside the New Orleans metro subsample, were the most commonly reported reasons for reducing or terminating treatment, at 84.0% and 74.0% across the two subsamples. https://pmc.ncbi.nlm.nih.gov/articles/PMC2248271/ 
9. Slubicki M, et al. Lithium Toxicity. StatPearls, NCBI Bookshelf. Because the kidney handles lithium similarly to sodium, sodium or volume depletion increases renal lithium reabsorption and decreases excretion; precipitants include dehydration, vomiting, diarrhea, fever, and low-sodium diets. NSAIDs and ACE inhibitors alter renal hemodynamics or sodium handling, increasing reabsorption or reducing clearance. https://www.ncbi.nlm.nih.gov/books/NBK499992/ 
10. Keks N, Hope J, Keogh S. Switching and stopping antidepressants. Australian Prescriber, 2016;39(3):76-83, which tabulates elimination half-lives: fluoxetine 4 to 16 days including norfluoxetine, vortioxetine 2.4 to 2.8 days, citalopram and escitalopram 1.5 days, sertraline 1.1 to 1.3 days, paroxetine 1.0 day, mirtazapine 0.8 to 1.6 days, amitriptyline 0.2 to 1.9 days, venlafaxine 0.6 days including desvenlafaxine, fluvoxamine 0.6 days, duloxetine 0.5 days, desvenlafaxine 0.4 days. https://pmc.ncbi.nlm.nih.gov/articles/PMC4919171/ Bupropion is not in that table: 21 hours, with erythrohydrobupropion about 33 and threohydrobupropion about 37 hours, from Wellbutrin XL prescribing information, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a435da9d-f6e8-4ddc-897d-8cd2bf777b21 Trazodone is biphasic, 3 to 6 hours initial and 5 to 9 hours terminal, from Cuomo A, et al., A narrative review on trazodone as a multimodal and multifunctional antidepressant, Annals of General Psychiatry, 2026;25:32, https://pmc.ncbi.nlm.nih.gov/articles/PMC13112903/ 
11. Therapeutics Letter 157: How to stop antidepressants. Therapeutics Initiative, University of British Columbia, 2025. Because the elimination half-life of many antidepressants is under a day, every-second-day dosing can produce wide fluctuations in drug concentrations and precipitate severe withdrawal effects. Patients on an antidepressant for only several weeks are at low risk of serious withdrawal compared with those with years of exposure, and resuming a withdrawn drug at a low dose months after stopping can have unpredictable effects including paradoxical worsening. https://www.ncbi.nlm.nih.gov/books/NBK618767/ The alternate-day modelling it draws on is O’Neill JR, et al., Alternate-day dosing to taper antidepressants risks severe withdrawal effects: an in silico analysis, Journal of Affective Disorders, 2026;392:120084, https://pubmed.ncbi.nlm.nih.gov/40848773/ 
12. Therapeutics Letter 156: Antidepressant withdrawal syndrome, update. Therapeutics Initiative, University of British Columbia, 2025. After 5 to 8 days of discontinuation, withdrawal occurred in 14% of patients taking fluoxetine against 60% taking sertraline and 66% taking paroxetine. Paroxetine, duloxetine, and venlafaxine/desvenlafaxine are disproportionately represented in WHO withdrawal reporting. https://www.ncbi.nlm.nih.gov/books/NBK618768/ 
13. Ochi S, et al. Disaster-Driven Evacuation and Medication Loss: a Systematic Literature Review. PLoS Currents Disasters, 2014. Seventy articles covering 27 events across 9 countries. Following Japan floods, 48% of evacuees left their medication behind and 88% left their prescription records behind. The 5.7x prepared-emergency-pack finding also comes from a single Japanese flood study inside this review rather than pooled across its 27 events. https://pmc.ncbi.nlm.nih.gov/articles/PMC4169391/