The palliative care sector has written to Health Minister Mark Butler, warning of “a looming crisis for palliative care patients of all ages as well as those with chronic pain, cancer and other conditions requiring effective pain control.”

Key health bodies including Palliative Care Australia (PCA), the Australian and New Zealand Society for Palliative Medicine, the Society of Hospital Pharmacists of Australia (SHPA), and Palliative Care Nurses Australia have detailed their concerns around forecast medicine shortages and reduced access to necessary and vital pain relief.

In early 2023, British pharmaceutical company Mundipharma announced it was removing oral liquid morphine (Ordine) from the Australian market.

Then in late October, the company flagged another nine products containing morphine or oxycodone, used in palliative care and chronic pain management, would be discontinued over the coming 18 months, including:

• OxyNorm capsules
• MS Mono capsules
• Sevredol tablets

It’s news that follows similar discontinuations in recent years, including:

• MS Contin sachets
• Jurnista tablets
• Dilaudid oral liquid

“This is a serious risk for all Australians requiring management of serious pain,” says Camilla Rowland, Chief Executive Officer, PCA.

“These discontinuations and shortages threaten the safe delivery of quality care - especially for vulnerable patients like young children and those with a cancer diagnosis. Not to mention the tremendous anxiety these announcements continue to cause clinicians, patients, and carers.”

While earlier advocacy from the sector has resulted in some alternative medicines being approved by the Therapeutic Goods Administration (TGA) for supply in the Australian market, it is important to note these are temporary measures, and that a high risk remains there will soon be no Australian-registered product for oral liquid morphine and other opioid medicine formulations.

The temporary solutions in place also come with barriers for some patient groups.

“The cost of alternatives sourced from overseas to replace locally-registered medicines is almost always higher, and this can be a barrier for many people and health services. There is no guarantee that the alternative product will be subsidised by the Pharmaceutical Benefits Scheme (PBS) either which can easily quadruple the cost of the discontinued Australian-registered product,” says Tom Simpson, President, SHPA.

“There have also been problems with labels written in foreign languages and the size of the deliveries we are receiving can make these alternatives hard to administer safely and cost effectively.”

The joint letter to Minister Butler puts forward several actions to address the risks to the community - reducing the impact of these decisions now and in the future:

• That the minimum reporting period of palliative care medicine shortages and discontinuations be extended from 6 months to 12 months.
• Earlier communication and engagement with clinicians and patients/carers to allow safe transition to alternative medicines.
• Review the current process for TGA registration and PBS listing to ensure critical medicines are affordable in a timely way. For example - waive application fees and invite pharmaceutical companies to make submissions for PBS listings for medicines of critical need or special populations free of charge.
• Proactive sourcing of additional opioid medicines and formulations by the TGA to enhance the options available to patients and health services.
• Noting that Australia is the second-biggest producer globally of the raw materials for opioid manufacture; consider ways of developing our sovereign capability and ensuring local supply.

“Working with our partners in the TGA’s Medicines Shortage Action Group and the Pharmaceutical Benefits Advisory Committee we have been able to move the dial, but action is now required at the highest levels of government to ensure the most vulnerable members of our community can access their human right to care and quality of life,” Ms Rowland says.

“We stand ready to play our part in finding solutions to ensure no patient goes without in their time of need.”