How Middle East Tensions Are Disrupting Medical (and Dental) Supply Chains

By Genni Burkhart, Editor

Supply chain pressure has been building for years. Hurricanes, pandemic-driven shortages, and rising tariffs have all disrupted the materials and medications critical to healthcare in the US. The ongoing conflict in the Middle East is now adding another layer to that pressure, as medications sedation practices use every day are directly impacted.

However, some of the biggest risks are not always visible at surface level. A recent U.S. Pharmacopeia analysis identified 100 essential medications at risk of disruption due to limited supplier diversity and concentrated production. Many of these drugs are still available today, but the structure behind them leaves little room for disruption when pressure builds in the supply chain.

Since the Iran conflict escalated in late February 2026, the fallout has disrupted global shipping lanes and pharmaceutical supply networks alike. The closure of the Strait of Hormuz, one of the world’s most critical maritime corridors for oil, gas, and global trade, also cut a key transit route for pharmaceutical shipments moving between Asia, Europe, and the United States.

While a tentative ceasefire was announced on April 7 and again on April 17, conditions in the Strait of Hormuz remain fluid. Iran has declared the strait open to commercial vessels; however, shipping traffic remains limited and is operating under new restrictions, with ongoing uncertainty across the region. At the time of this article, mid-April 2026, access is partially restored, but the situation continues to shift, and critical medical supply routes remain at risk.

Here's how this is impacting dental practices in the US based on what we know right now.

Dental Sedation Drugs Most at Risk

Jordan and Israel hold a small share of global pharmaceutical output, but they’ve concentrated production in a handful of specific compounds that matter directly to dental sedation. Reporting from The Hill, citing the U.S. Pharmacopeia (USP) risk assessment, identifies three medications where that concentration creates vulnerability in supply.

The following medications carry the most concentrated regional production risk:

• Jordan produces approximately half of the world’s amoxicillin oral suspension, a widely used antibiotic in dental prophylaxis protocols and post-procedural care.
• Jordan also produces roughly half of the global API for etomidate, the fast-acting intravenous anesthetic central to IV sedation protocols.
• Israel and Jordan together account for 73% of the global API for flumazenil, the required benzodiazepine reversal agent in IV and moderate sedation practice.

The USP notes that therapeutic alternatives exist for each of these medications, and Michael Ganio, senior director of pharmacy practice and quality for the American Society of Health-System Pharmacists (ASHP), confirmed in the same Hill article that the healthcare system has navigated past shortages of these specific products and has mitigation strategies in place. For now, supplies are holding, although the longer the conflict persists, the more pressure builds on those alternatives.

A Much Larger Issue: Generics

Unfortunately, the supply chain disruption extends beyond the three medications mentioned above. In reality, nearly every generic drug dispensed in the United States travels through the same corridor impacted by conflict.

India is a powerhouse as the world’s largest producer of generic drugs, supplying 47% of the generics dispensed in the United States. To reach their final markets, those medications travel through shipping routes along the Red Sea and the Strait of Hormuz. David Weeks, the Texas-based director of supply chain risk management at Moody’s, framed the dependency plainly: “India is known as the pharmacy of the world. With the geopolitical situation, it’s harder and harder to get those out.”

With those routes now constrained, cost pressure and potential delays are rising across the entire category of generic drugs, including the antibiotics, analgesics, and anesthetics that dental practices routinely order. Michael Ganio of the ASHP also described the effect of disrupted trade routes on access to generic drugs as “almost an indirect tariff.”

Adding additional strain to the supply chain, air freight is the primary mode of transport for temperature-sensitive pharmaceuticals, and the two largest pharmaceutical air cargo hubs, Dubai and Doha, have faced significant disruption from airspace closures and conflict-related damage.

The disruption reaches medical packaging components as well. Supply chain analysts have identified vial stoppers and IV bag plastics as vulnerable because these components travel through the same disrupted corridors. For practices providing IV sedation, a shortage of materials used to enclose and deliver medications is as disruptive as a shortage of the medications themselves.

That kind of upstream vulnerability is hard to spot in real time. Even when it looks like there are multiple manufacturers for a medication, many of them rely on the same starting materials from a single country. As a result, what appears to be a diversified supply chain can still depend on one source behind the scenes.

USP analysis also found that nearly half of essential medicines rely on at least one input produced exclusively in one nation, which creates a single point of failure that is easy to miss until disruptions begin.

Oil and the Cost of Every Drug

Petroleum is a raw material for nearly every drug manufactured anywhere in the world. In fact, a 2011 analysis in the American Journal of Public Health found that 99% of pharmaceutical feedstocks and reagents are derived from petrochemicals. The Strait of Hormuz also handles roughly a fifth of the world's oil and natural gas supply. When that corridor tightens, cost pressures extend through every stage of drug production, from raw materials to the package on a distributor's shelf.

While the full effects have yet to be felt, impacts are already showing up. In the United Kingdom, a National Pharmacy Association (NPA) survey found that 86% of pharmacies reported aspirin shortages after a recent distribution disruption drove the price of a single box from 38 pence to £7.82. Off-patent drugs, the category that covers most generic antibiotics and anesthetics, run on thin margins. Sustained cost pressure forces those manufacturers out before shortages are visible downstream, and those are exactly the generic antibiotics and anesthetics that dental practices stock, reorder, and depend on to keep their practices running smoothly.

Furthermore, this pressure does not stop at fuel or shipping. Much of the U.S. drug supply relies on materials and ingredients sourced internationally, which means the same disruptions affecting oil and transport can also affect manufacturing. When those pressures build at multiple points in the supply chain, availability can shift quickly, even when the original disruption starts far outside the healthcare system.

Getting Ahead of Supply Chain Shortages

Research from Argon and Co. found that only 22% of pharmaceutical firms had active disruption planning in place at the end of 2025. For dental practices, that's information worth taking seriously. The strategies The Incisor outlined in the article, Top 5 Strategies to Help Dentists Offset Supply Chain Shortages apply directly here, and a few key points stand out:

• Prioritize supplier relationships. For flumazenil, etomidate, and amoxicillin oral suspension, contact your distributor directly to inquire about sourcing, current inventory, and allocation policies. A named contact rather than a general customer service line means a faster response when supply gets constrained.
• Leverage a group purchasing organization. GPOs negotiate directly with manufacturers and typically secure pricing 20 to 25% below standard rates. Their collective buying power gives members access to allocation tiers that individual practices rarely reach on their own, and that access matters most when supply is short.
• Diversify your distributor base. If one supplier faces constraints, having a second account already active means a faster pivot with less disruption to your schedule.

The three medications at the center of this story, flumazenil, etomidate, and amoxicillin oral suspension, are routine medications needed in sedation dentistry, and not interchangeable on short notice. Given that, a prepared, proactive approach is best. A secondary supplier relationship built today, a GPO membership activated now, and a backup distributor account on file are the difference between continuity of care and a disrupted schedule—be it due to war, weather, or a global pandemic.

References:

1. ACAPS. (2026, March 20). Middle East conflict: Ripple effects and scenarios. ACAPS Thematic Report.
2. Murphy, F. (2026, April 10). Trump's war with Iran is threatening medical supply chains, experts warn. BMJ, 393, s690.
3. Choi, J. (2026, March 29). Pharmaceutical supply chains get tangled in war with Iran. The Hill.
4. Jeffries, E. (2026, March 30). The medications most at risk amid Iran war-driven supply threats. Becker's Hospital Review.
5. Fick, M. (2026, March 16). Middle East war disrupts pharma air routes, risks cancer drugs supply. Reuters.
6. Collins, L. (2026, April 6). How conflict reveals pharma supply chain vulnerabilities. Supply Chain Digital.
7. Bell, D., & Christel, M. (2026, April 8). Q&A: Supply chain fallout from Iran war, tariff uncertainty. Pharmaceutical Executive.
8. O'Brien, I. (2026, April 1). Supply chains and trials hit by Middle East instability. EMJ Gold.
9. U.S. Pharmacopeia. (2025). Vulnerable medicines list. USP.
10. Bergeson, L. (2026, April 16). Hidden supply-chain risks threaten 100 essential US medicines. CIDRAP.

Author: With over 16 years as a published, award-winning journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.