Morphine shortage stressing out patients, caregivers

Some dying patients struggling to access liquid morphine as supplies dwindle across the country.

When Molly Fletcher told her dying dad she couldn’t get his normal liquid morphine painkiller, he refused to eat all day.

He’d already had to switch from his usual 1mg/ml solution to a double-strength one, as a failed Pharmac tender means there will be no more supplies of the mostused strength of the essential painkiller until June.

But when Fletcher went to her Kaikohe pharmacy to pick it up, the replacement 2mg/ml supply still hadn’t arrived.

So until Tuesday, he has to take morphine tablets. That’s another GP appointment, another prescription, more stress for a man who has already suffered lung cancer, liver cancer and asbestosis from working as a boiler-maker.

“Dad is far enough along where he’s starting to get a lot of anxiety now,” Fletcher said. “If he doesn’t have his medication, he gets highly agitated ... It’s a nightmare.

“I’m pretty angry. I think there’s a duty of care when it comes to giving a controlled substance that has addictive properties to a patient, and then pulling it out from under them.”

Drug company Pfizer gave Pharmac two years’ notice that it would stop supplying RA-Morph liquid morphine, as it was closing the Perth factory that makes it. However, Pharmac failed to secure a replacement supply in time. Another company, Bridgewest, took over Pfizer’s factory and RA-Morph production, but can’t supply New Zealand until June.

Pharmac eventually found a 2mg/ml replacement supply of a different brand not approved by Medsafe, which it said should be available now.

But Kaikohe pharmacist Alex Graham said he was still waiting on delivery.

“We’ve been trying to manage supply over the past few months. We’ve come to the sticky end of it now, unfortunately... It would have been helpful if the replacement product had been available before everybody ran out.”

While patients could switch to fast-acting morphine tablets, that was no good for those unable to swallow pills, Graham said. Changing morphine strength was also “fraught with danger”, because it could lead to unintentional overdoses.

While pharmacists contacted in Wellington, Auckland and Tauranga all had some remaining liquid morphine stock, one Tauranga pharmacist only had enough for one patient.

Palliative medicine specialist Delamy Keall said the switch to a double-strength solution not approved by Medsafe would cause “a lot more hassle and to-ing and froing for patients and families”.

“Everybody is having to be very careful and having to adjust”.

Hospice New Zealand chief executive Wayne Naylor said Pfizer’s decision to quit supplying the cheap but essential liquid morphine raised serious questions.

“If Big Pharma is focused on profit, not on people, that’s a concern.”

(Pfizer previously said the move was not profit-driven.)

However, the situation also highlighted flaws in Pharmac’s supply processes, Naylor said.

“I would hope Pharmac has learnt a significant lesson and is making sure they have alternative supplies of commonly used medications.”

Pharmac director of pharmaceuticals, Geraldine MacGibbon, confirmed there was no more stock of the 1mg/ml and 10mg/ ml RA-Morph, and supplies of the 2mg/ml would run out in coming weeks.

A “small amount” of alternative 2mg/ml Wockhardt brand liquid morphine should be available now, with another brand coming onstream later in March, she said. She acknowledged medicine shortages could be “distressing”.

“We work hard to prevent or limit the impact of these shortages on people who use them and their whānau where we can.”