New advice to clinicians on shortages of oral morphine

By Michael Woodhead

10 Jul 2024

Pain relief for cancer patients is facing ongoing problems with long term disruptions affecting supplies of analgesics such as oral liquid morphine set to continue this year, according to Palliative Care Australia.

Shortages arose in early 2023, when the oral liquid morphine product Ordine was removed from the Australian market by MundiPharma.

Since then, ad-hoc arrangements for substitute oral morphine products have caused anxiety and inconvenience for patients, their families, and health professionals. PCA says.

While more reliable supplies of alternative products will hopefully start to take effect during August, PCA says that in the meantime, doctors, nurses, pharmacists, and carers are being asked to manage fluctuating supplies on a week-by-week basis.

“For many clinicians, the challenges around a lack of guaranteed supply of medicines has been ongoing for 18 months or more,” said CEO Camilla Rowland.

“This is an issue the palliative care sector has been managing for too long, and right now PCA and our members around Australia are hearing from increasingly frustrated and distressed clinicians.”

Following advocacy from the sector, the TGA sourced and approved a range of alternative temporary medicines (Section 19A products) to fill the gap while a new manufacturer of Ordine established itself and supply. Advice from the TGA suggests that a more reliable, consistent supply channel will start to take effect in August this year.

However, supplies of the temporary medicines (Section 19A products) have also proven problematic and not provided the reassurance patients and the sector hoped for.

“We are in regular communication with the TGA on this issue and I want to thank them for their efforts to source alternative medicines as we all grapple with an ever more challenging global supply chain,” Ms Rowland said

PCA Chair, and practicing palliative care physician in south west Sydney, Prof Meera Agar said that having to swap between various products to fill the gap in the supply chain is an unnecessary workaround with significant impacts for people where time is precious.

“Pain management requires an individualised approach. It’s work we do side by side with the patient and their carer, who is often the person administering this medication,” Prof Agar said.

“Use of a particular medicine is supported by experience, education, and evidence – but instead we find ourselves needing to ring around and find supplies, adding medical appointments, getting scripts, relearning a new medication regimen – and having to communicate that to people at a time where they are unwell.

“It’s easy to get confused about how to manage your medications when it keeps being swapped around depending on supply, not to mention the side-effects that can come from new and changing medicines.”

Dr Peter Allcroft, a palliative care specialist working in Adelaide, said he was hopeful that once supplies of Ordine from the new supplier become available, the current pressure on fellow clinicians will ease.

“The ongoing difficulty with access to reliable medications has been a concern, particularly as these are medications that our clinicians feel comfortable with and have experience using,” said Dr Allcroft, who is PCA Deputy Chair.

“While it has been reassuring to have other pain relief options available for the families in our care, it’s important to note that access to pain relief is a basic human right

“PCA and the sector more broadly would welcome the opportunity to work collaboratively with government to ensure that Australia has a stable supply of this critical medicine into the future.”


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