GPs forced to manage critical pain relief shortage ‘as best we can’

A ‘challenging global supply chain’ is causing a critical shortage of pain medication and creating anxiety for dying patients and forcing physicians to manage fluctuating supplies, according to a fresh warning from Palliative Care Australia (PCA).
 
And while there are hopes a longer-term solution will start to take effect during August, doctors, nurses, pharmacists, and carers are currently being asked to manage fluctuating supplies on a week-to-week basis.
 
Professor Geoffrey Mitchell, an RACGP Fellow and the recipient of the 2023 National Palliative Care Awards Lifetime Achievement Award, is at the very end of ‘the supplies that are around’.
 
‘It just makes things a bit more difficult, and you just have to work your way around it,’ he told newsGP.
 
Australia’s shortage stems from a mid-2023 decision to remove oral liquid morphine from the market, with the medication’s sponsor, Mundipharma, citing the closure of an overseas factory.
 
Professor Mitchell is retiring this week, but is well aware of the ongoing challenges his colleagues face as the medication becomes more unavailable.
 
‘Liquid morphine is really useful because it comes in different strengths and it’s very easy to adjust the dose,’ he said.
 
‘Without that you have to revert to oral tablets, in 10 or 20 milligrams, whereas the liquids are one milligram per mil.
 
‘There are liquid opioids available but, in Queensland anyway, they are only available through the hospital.’
 
PCA Chair, and practising palliative care physician, Professor Meera Agar, says having to swap between various products to fill the supply chain gap is an unnecessary workaround.
 
‘Use of a particular medicine is supported by experience, education, and evidence,’ Professor Agar said.
 
‘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.’
 
The shortage is also being mirrored in other aspects of care across the country, with NSW GPs recently told to cut down on antibiotic prescriptions amid a nationwide shortage, while AHDA medication lisdexamfetamine dimesilate is again experiencing supply issues. Patients with diabetes are likewise having difficulty accessing semaglutide, with no end to the shortage in sight.
 
PCA CEO Camilla Rowland says everyone is having to ‘grapple with an ever more challenging global supply chain’.
 
Within the context of palliative care, Professor Mitchell says there is a risk doctors may end up either over-medicating or under-medicating patients on non-liquid pain medications.
 
‘Sometimes we get to get it wrong and overdo it, which can lead to side effects,’ he said.
 
‘Also, it might be that doctors are unwilling to risk that and under-do the medication, so the patient remains in pain.
 
‘But we’re just going to have to manage it as best we can.’
 
The PCA says the Therapeutic Goods Administration (TGA) has indicated that a more reliable, consistent supply channel will start to take effect in August.
 
More information on the Ordine oral liquid discontinuation is available on the TGA website.
 
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