According to the FDA, IV morphine, hydromorone, and fentanyl are currently in short supply[1]. Shortages of IV opioids in hospitals trigger drug rationalization processes, as the supply chain is vulnerable at every stage[1]. Hospitals try to rotate medications and replace them with alternatives to ensure adequate pain management[1]. Researchers propose a framework for the allocation of shortage painkillers that primarily asks how to reduce severe suffering while respecting patients' self-reports of pain[1]. This framework recognizes that certain groups, including children and dying patients, may deserve priority[1]. Drug rationalization decisions must be made in advance at the institutional level and cannot be left to clinicians who have to make them in real time[1]. IV opioid shortages are a predictable feature of American medicine due to centralized manufacturing, vulnerable facilities, and rigid regulatory constraints[1].