Supply Chain Break For Medications in Physical and Rehabilitation Medicine: A Risk-based Framework for Preparedness

Pharmaceutical supply chain disruptions from pandemics, natural disasters, and geopolitical conflicts increasingly threaten medications central to rehabilitation practice. Rehabilitation pharmacotherapy is especially exposed because many core agents have narrow therapeutic windows, require cold-chain logistics, lack ready substitutes, or carry life-threatening consequences when abruptly interrupted. This analysis examines vulnerabilities across three rehabilitation medication categories: spasticity-targeted therapies, pain and musculoskeletal therapeutics, and neurorehabilitation agents. We describe the clinical consequences of medication interruption across rehabilitation populations, then define and apply an expert-derived, literature-informed stockout risk matrix that classifies events along two dimensions. These dimensions comprise likelihood of stockout (manufacturer concentration, logistics chain integrity, lead time, and price volatility) and severity of clinical consequence (withdrawal-related morbidity, substitutability, and size of the affected patient population). The 2026 Strait of Hormuz crisis, during which Gulf Cooperation Council countries faced potential threats to the availability of medications across multiple logistics corridors, serves as a contemporary case illustration. A contingency framework that includes strategic reserves, protocol switching, telerehabilitation-based monitoring, and cross-border mutual aid is then outlined. Preparedness for pharmaceutical supply disruption appears to be an underdeveloped competency in Physical and Rehabilitation Medicine and merits attention in service delivery wherever import dependence or disruption risk applies.