Key health organisations are stepping up their advocacy efforts, with supplies of a critical pain relief medication forecast to run out soon. People nearing the end of their life or undergoing cancer treatment, including children with life limiting illness, are most at risk from dwindling supplies of oral liquid morphine.
A group of 18 organisations, led by Palliative Care Australia, have joined forces to amplify the concerns expressed by health professionals and patients. The risks stem from a combination of factors, including global supply chain disruptions, regulatory changes, changes in opioid prescribing patterns, and business decisions by individual pharmaceutical companies.
In recent correspondence, pharmaceutical company Mundipharma announced that it is no longer able to supply the Australian market with its oral liquid morphine product, known under the brand name ‘Ordine’.
PCA says oral liquid morphine is on the World Health Organisation’s list of essential medicines. It is a gold standard treatment for management of pain and shortness of breath. It is also widely used for children and adults undergoing curative cancer treatment, particularly when treatment is associated with significant pain or the patient’s ability to swallow is compromised.
There are no appropriate alternatives currently available in Australia for these patients and without it, people may not be able to tolerate the treatments they need.
Factory closed
In explaining the withdrawal of Ordine from the Australian market, Mundipharma pointed to the closure of an overseas factory.
The Therapeutic Goods Administration’s medicine shortage database shows existing supplies of Ordine are forecast to run out some time between December 2023 and March 2024.
The TGA has issued a statement with further information.
Josh Fear, National Policy Director, Palliative Care Australia, said ‘this is the fourth opioid to have supply challenges in Australia in recent times. Due to Australia’s system for regulating medicines, it can take months for an alternative supplier to be found, then for the same medicine to be re-approved by the TGA, and then finally for it to be re-listed on the Pharmaceutical Benefits Scheme (PBS) – if a replacement is found at all.
‘PBS listing is critical for meaningful and equitable access,’ he said. ‘Without PBS subsidy, prices can be very cost-prohibitive for patients and their families. As global supply chains become more complex, Australia needs more nimble systems for anticipating and responding to disruptions in the supply of essential medicines. We also need a better way of communicating with clinicians and patients.
‘Until then, these kinds of announcements will continue to cause anxiety and frustration for very vulnerable people and their treating clinicians,’ said Mr Fear.
A growing problem
A number of health organisations have already written to Health Minister, Mark Butler, highlighting the issue.
‘The bigger issues at play here are not new, and we are hopeful that a government focused on health reform and patient care can respond and put people at ease,’ said Mr Fear.
‘Globally, Australia is the second-largest producer of the raw materials for morphine, yet we are still regularly experiencing supply problems. There is an opportunity here to develop our sovereign capability and manufacture essential medicines right here in Australia.
‘In the meantime, we look forward to working with the TGA as it works to find a replacement for this essential medicine as quickly as possible.’
Concerned groups who have joined the public call for urgent action include: Palliative Care Victoria, Palliative Care Queensland, Palliative Care South Australia, Palliative Care Tasmania, Palliative Care NSW, Palliative Care ACT, Palliative Care Western Australia, Australian and New Zealand Society of Palliative Medicine, Palliative Care Nurses Australia, Paediatric Palliative Care Australia and New Zealand, Quality of Care Collaborative Australia, Pain Australia, Australian Pain Society, Head and Neck Cancer Australia, Clinical Oncology Society of Australia, MND Australia, and the Society of Hospital Pharmacists of Australia.
