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

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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.

Patients can receive palliative care in a range of settings, including at home or in specialist centres.
Studio DC/Shutterstock

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.

Bottle of oxycodone next to oral syringe.
There are many varieties of opioids. They could be taken in some ways, including orally in liquid or capsule form.
photo by makasan/Shutterstock

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.

This article was originally published on : theconversation.com
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Health and Wellness

US communities phase out fluoride use in public drinking water

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fluoride, water


There is a battle raging in American cities over whether to proceed using fluoride in water.

This is a process generally known as fluoridation that began around 1945. According to to the American Cancer Society became popular across the country after scientists noticed that individuals living in water with higher concentrations of fluoride had less tooth decay.

In 1962, the U.S. Public Health Service (PHS) advisable adding fluoride to public drinking water supplies to forestall tooth decay. The American Cancer Society estimates that fluoride is currently used in public drinking water supplied to roughly three in 4 Americans.

However, opponents have been warning for years that fluoride in drinking water is unsafe to devour. One of the organizations leading this initiative is Fluoride Action Network (FAN). The organization, whose mission is to lift awareness of what it claims is the “toxicity of fluoride compounds,” says many of the world’s developed countries don’t use fluoride in drinking water at the identical levels as America, or in any respect.

The organization says yes it helped over 500 communities successfully reject fluoridation, and there could also be more.

Federal leaders have gotten increasingly vocal in their support for ending the use of fluoride

While FAN says communities have rejected fluoridation for the past few a long time and the method has stalled in consequence, the fight has been thrust into the highlight over the past few months.

First, the National Toxicology Program, a federal agency throughout the Department of Health and Human Services, reported with “moderate certainty” that there may be an association between communities with higher levels of fluoride exposure and lower IQ in children. According to the Associated Press, these communities use greater than twice the advisable limit.

A month later, a federal judge apparently ordered the U.S. Environmental Protection Agency (EPA) to further regulate fluoride in drinking water because higher levels could affect children.

Robert F. Kennedy, nominated by President-elect Donald Trump to direct the Department of Health and Human Services, announced an end to fluoridation.


This article was originally published on : www.blackenterprise.com
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Health and Wellness

WATCH: Cynthia Erivo on the importance of being a sister – Essence

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This article was originally published on : www.essence.com
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Health and Wellness

Phenergan is no longer recommended for children under 6 years of age due to the risk of hallucinations. Here’s what you can use instead

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The Australian Drugs Regulatory Authority has issued an order safety warning over Phenergan and related products containing the antihistamine promethazine.

The Therapeutic Goods Administration has stated that over-the-counter products shouldn’t be given to children under six years of age due to concerns about serious unwanted side effects akin to hyperactivity, aggression and hallucinations. Breathing may turn into slow or shallow, which can be fatal.

When high doses are administered to young children, difficulties in learning and understanding, including reversible cognitive deficit and mental disability, may occur. – said the TGA.

The latest warning follows international and Australian concerns about the drug in young children, which is commonly used to treat conditions akin to hay fever and allergies, motion sickness and for short-term sedative effects.

What is promethazine?

Promethazine is a “first generation” antihistamine that has been sold over the counter in Australian pharmacies for a long time for a spread of conditions.

Unlike many other drugs, first-generation antihistamines can cross the blood-brain barrier. This means they affect your brain chemistry, making you feel drowsy and sedated.

In adults, this will likely be useful for sleep. However, in children, these drugs can cause serious unwanted side effects on the nervous system, including those mentioned on this week’s safety alert.

We’ve known about this for a while

We have known about the serious unwanted side effects of promethazine in young children for a while.

Advice regarding 20 years ago In the United States, the drug was not recommended for use in children under two years of age. In 2022, an Australian Medicines Advisory Committee made its own suggestion to increase the age to six. New Zealand released similar warnings and advice in May this 12 months.

Over the last ten years, there have been 235 cases of serious unwanted side effects from promethazine in each children and adults reported to the TGA. Of the 77 deaths reported, one was a toddler under six years of age.

Reported unwanted side effects in each adults and children included:

  • 13 cases of accidental overdose (leading to 11 deaths)
  • eight cases of hallucinations
  • seven cases of slow or shallow respiration (leading to 4 deaths)
  • six cases of decreased consciousness (leading to five deaths).

TGA security alert comes after an internal investigation by the manufacturer of Phenergan, Sanofi-Aventis Healthcare. This investigation was initiated in 2022 advice from the Medicines Advisory Committee. The company has now updated its information for consumers and healthcare professionals.

What can you use instead?

If you have allergies or hay fever in young children, non-sedating antihistamines akin to Claratine (loratadine) or Zyrtec (cetirizine) are preferred. They provide relief without the risk of sedation and other disturbing unwanted side effects of promethazine.

If symptoms of a chilly or cough occur, parents must be reassured that these symptoms will normally subside with time, fluid intake, and rest.

Saline nasal sprays, adequate hydration, a humidifier or elevating the child’s head can relieve the congestion related to hay fever. Oral products containing phenylephrine marketed for nasal congestion must be avoided because evidence shows that this is the case This article was originally published on : theconversation.com

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