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

Australia is currently in a singular situation since it is concurrently opioid epidemic and we’re experiencing a shortage of these essential 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 yr.

This is an issue for the near future 100,000 people receiving palliative care who may depend on opioids akin to morphine to administer each day chronic pain.

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

Opioids are essential for people in palliative care

Palliative care goals to supply quality of life for individuals with illnesses which have little or no probability of recovery. Anyone can need palliative care, including infants, children, and adolescents, not only adults and older people.

Patients may remain in palliative care for days, weeks, and even months and typically struggle with chronic pain each day. Opioid drugsakin to morphine, are commonly used to alleviate pain, suffering and discomfort.

Morphine is a robust painkiller, often used when other medications, akin to ibuprofen and acetaminophen, aren’t any longer effective. It works block the pathways in the brain which register the feeling of pain.

Morphine could 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 a very important form of medication for individuals who cannot take tablets, including young children, elderly patients, and other people who’ve difficulty swallowing.

Why are we missing these drugs?

Since the emergence of COVID-19, we now have seen continued shortages of many medicines on account of 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 look like attributable to COVID-19.

In June last yr, the international company Mundipharma, which produced the one registered brand liquid morphine used in Australia, Ordine, he advised the federal government has stopped deliveries. Australian company Arrotex Pharmaceuticals is set to take over supply. However, supplies will not be expected to return to normal until their products grow to be available – likely in late 2024.

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

Can you replace one opioid with one other?

There are many differing types of opioid medications, which implies that when one is unavailable, a patient could also be switched to a different. 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 fit kind of effectively than the identical dose of one other 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 a different opioid, your doctor may additionally reduce dose by 50%This is because stronger opioid medications akin to fentanylat higher concentrations they’re very dangerous and usually tend to cause respiratory difficulties and even death.

Dose adjustment The way the drug is administered is also vital. For example, the dose needed when injecting morphine is normally 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 identical way and are equally effective in treating pain.

In Australia, there are reports that some patients still do not need access to opioid medications inside the Australian health care system. paying as much as $4,000 source your individual supplies from abroad.

But these are stopgap measures, just like those currently getting used to handle the shortage of intravenous fluids, and are one other example of why the Australian Government needs to speculate 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 find out the perfect approach to maintain you or your beloved pain-free.