Australia is running out of oral morphine. What does this mean for pain relief in palliative care?

Australia is currently in a unique situation because it is simultaneously opioid epidemic and we are experiencing a shortage of these necessary medicines.

The Therapeutic Products Agency has approved eight oral morphine products list of shortagesThe supply problem for these products is not expected to be resolved before October or November of this year.

This is a problem for the near future 100,000 people receiving palliative care who may rely on opioids such as morphine to manage daily chronic pain.

So why are we missing out and what are doctors and patients doing?

Opioids are necessary for people in palliative care

Palliative care aims to provide quality of life for people with illnesses that have little or no chance of recovery. Anyone can need palliative care, including infants, children, and adolescents, not just adults and older people.

Patients may remain in palliative care for days, weeks, or even months and typically struggle with chronic pain on a daily basis. Opioid drugssuch as morphine, are commonly used to relieve pain, suffering and discomfort.

Morphine is a robust painkiller, often used when other medications, such as ibuprofen and acetaminophen, are no longer effective. It works block the pathways in the brain which register the sensation of pain.

Morphine can be taken as a tablet, capsule or liquid orally, by injection, or intravenously. pump patient controls. The eight morphine products Australia has shortlisted are all oral forms (tablets and liquids).

Liquid forms of morphine taken orally are an essential form of medication for people who cannot take tablets, including adolescent children, elderly patients, and people who have difficulty swallowing.

Why are we missing these drugs?

Since the emergence of COVID-19, we have seen continued shortages of many medicines due to Supply chain disruptions and other issuesThere are currently 377 drugs on the Therapeutic Goods Administration list. list of shortages. However, the shortage of morphine-containing medicines does not appear to be caused by COVID-19.

In June last year, the international company Mundipharma, which produced the only registered brand liquid morphine used in Australia, Ordine, he advised the government has stopped deliveries. Australian company Arrotex Pharmaceuticals is set to take over supply. However, supplies are not expected to return to normal until their products become available – likely in behind schedule 2024.

While the current shortage is oral morphine, other opioids are also coming out of stock, such as fentanyl (six products on the shortlist) and oxycodone (three products). That’s because when one drug, like morphine, is in miniature supply, demand for similar drugs increases.

Can you replace one opioid with another?

There are many different types of opioid medications, which means that when one is unavailable, a patient may be switched to another. What matters is which medication is being replaced – and at what dose.

Because of how the body metabolizes opioids, a dose of one drug may work more or less effectively than the same dose of another opioid. In these cases, the pharmacist must calculate what is called an “equivalent pain dose” when switching opioids.

In addition to calculating the equivalent dose when changing to another opioid, your doctor may also reduce dose by 50%This is because stronger opioid medications such as fentanylat higher concentrations they are very risky and are more likely to cause breathing difficulties and even death.

Dose adjustment The way the drug is administered is also essential. For example, the dose needed when injecting morphine is usually much lower than when taken orally as a tablet or liquid.

What is being done about this shortage and what next?

The Australian government has approved three foreign substitute products to fill the gap until supply returns to normal. They are sponsored by an Australian company Medsurge healthcare and include two liquid formulations of morphine sulfate and one liquid formulation of morphine chloride. Both work in the same way and are equally effective in treating pain.

In Australia, there are reports that some patients still do not have access to opioid medications within the Australian health care system. paying up to $4,000 source your own supplies from abroad.

But these are stopgap measures, similar to those currently being used to address the shortage of intravenous fluids, and are another example of why the Australian Government needs to invest in local medicines production.

If you or a loved one needs pain relief through palliative care, there are still many options. Talk to your doctor to determine the best approach to keep you or your loved one pain-free.