(CNN) — As drug shortages near record levels in the United States, a new survey shows how widespread — and serious — the effects are.

About 99% of health care system pharmacists who were surveyed — the vast majority of whom work in hospitals — say that they are experiencing drug shortages, including nearly a third who say the current shortages are “critically impactful,” leading to rationing, delaying or canceling treatments or procedures.

There were 309 active drug shortages in the second quarter of the year, according to the latest data from the University of Utah Drug Information Service — the most there have been in nearly a decade, topped only by the third quarter of 2014 when there were 320 active shortages.

More than 1,000 members of the American Society of Health-System Pharmacists responded to an internal survey between late June and mid-July this year, representing a sample of the professional association’s membership.

Chemotherapy drugs are among the top five categories of drugs with the most active shortages — and those shortages are viewed as the direst, with 57% of pharmacists saying they’re “critically impactful” with direct effects on patient care.

Health care systems and pharmacists have been managing various drug shortages for years, but the cancer drug shortages are much more difficult and much more serious than most others, said Mike Ganio, senior director of pharmacy practice and quality at ASHP.

“You’re talking about an entire treatment protocol for a patient and that’s being affected by one drug being in short supply,” he said. “We have a drug of choice or a treatment of choice for a reason. So when you start switching, you’re now either compromising the efficacy, you’re introducing new or more severe side effects, or you’re adding expense to our health care costs.”

A separate survey of major cancer centers published in June found that 93% couldn’t find enough carboplatin and 70% had cisplatin shortages, which are used in combination to cure many types of cancer. The Biden administration has worked with China on a special allowance to import cisplatin to help ease the shortage, but the drug remains on the US Food and Drug Administration’s shortage list.

Shortages of corticosteroids and other hormonal drugs, as well as oral liquids such as amoxicillin, have also had the most effects on patient care, according to the new survey from ASHP.

Overall, more than 40% of health care system pharmacists say that they’ve had to delay or cancel treatments or procedures because of a drug shortage. The vast majority also say they’ve rationed drugs (85%) or changed to therapeutic alternatives (97%).

In March, the US Senate Committee on Homeland Security and Governmental Affairs published a report on the risks that drug shortages pose to the nation’s health and national security. Increased demand can cause shortages, but the way drugs are made and sold for the US market is also a large part of the problem, experts said at a related hearing.

ASHP has recommended policy solutions to address the shortage, with short-term actions that include penalties for drug manufacturers who do not have risk strategies in place and longer-term actions that include diversifying the broader manufacturing supply chain.

Strategies need to be more proactive than reactive, Ganio said, and that will require a deeper investment in drug manufacturing quality.

The new survey found broad support for this, too. About 85% of pharmacists said that they would be willing to spend more for drug products from manufacturers that were recognized by a quality recognition program, with about 1 in 8 willing to raise their spending by at least 15%.

“If purchasers had more information to support those manufacturers that have better quality investments, better quality systems in place, more resiliency in their system — then I think we would be able to start to address some of these core root causes and problems,” Ganio said.

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