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Cancer and chronic pain patients hit by new opioid discontinuations

Key points:

  • Doctors say a “health crisis” is looming because several opioid medicines have been discontinued

  • Pain groups say children, the dying and cancer patients will be hit hard

  • They are calling on the government to prevent drugs being pulled so easily, or make them here

There are growing concerns about a significant shortage of opioid pain medicines given to some of the sickest Australians.

More than a dozen types of opioid products have been discontinued in the past year and doctors say this massive narrowing of the market is restricting what they can give their vulnerable patients.

Kathy Claxton lost her pancreas to neuroendocrine cancer four years ago and lives with the pain of neuroendocrine tumours in her liver.

The mother-of-three lost access to the liquid morphine product Ordine when all four strengths of the medicine were discontinued mid-year.

She is now about to lose access to their replacements Sevredol and Oxynorm after supplier Mundipharma announced in October that five morphine and oxycodone products would also be discontinued over the next 18 months.  

Ms Claxton uses the medicines for breakthrough pain and says without them she cannot care for her three teenage children.

“The worst the pain ever gets is when you can’t physically do anything — all I want to do is be in bed,” she said.

The NSW woman recently spent five weeks in hospital trying to get on top of her pain and said if the opioids kept disappearing, she would end up back there on a morphine drip for the rest of her life. 

“It’s starting to concern me as to why are they going off the market,” she said. 

‘Health crisis’ looming 

Palliative Care Australia chief executive Camilla Rowland said a “health crisis” was looming and sick children, the dying and those with chronic pain would be hurt the most. 

Palliative Care Australia is one of four health bodies that have written to Health Minister Mark Butler to raise concerns about what they say are vital pain relief medicines.

“This is a serious risk for all Australians requiring management of serious pain,” Ms Rowland said.

Other products being discontinued include four strengths of MS Mono capsules, MS Contin sachets, Jurnista tablets and Dilaudid oral liquid.

An estimated 270,000 scripts of the discontinued drugs are filled each year, meaning options for thousands of Australians have been limited. 

The health groups have called on Mr Butler to force pharmaceutical companies to extend notice of discontinuations from six to 12 months, consult with clinicians, review processes so alternatives can get PBS listing quickly and proactively look for alternative products.

They also want the government to consider ways to manufacture the medicines locally, given Australia is one of the world’s largest producers of pharmaceutical opioid poppies.

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Medicine withdrawals raise questions 

Australia and New Zealand Society of Palliative Medicine president Michelle Gold said it was hard to understand why the medicines had been discontinued at short notice. 

Opioids can vary in strength and side effects, as well as whether they are quick-release to manage sudden bursts of breakthrough pain or slow-release to give patients long-term relief.

Liquid morphine is used for pain relief in sick children and others who have trouble swallowing.

“These medications perhaps aren’t coming off patent or not making sufficient income for the company,” she said. 

Some alternatives have now been approved for use but doctors say they are only a stopgap, with one Swiss brand not even labelled in English.

Dr Gold said she was concerned by the lack of social responsibility from companies that received millions in tax-payers funds. 

“Surely they should have some moral obligation to ensure that people are not left without essential medications simply because a product becomes less profitable,” she said.

Pain meds shortage now a high priority 

MundiPharma, which supplies the medicines, said in a statement the products were withdrawn “after careful consideration” and most had alternatives.

“This was a global business decision, based on the complexity of continuing to provide these products in certain markets,” the company said. 

“With Ordine, Mundipharma is currently exploring all possible options and is still seeking continuation of Ordine for Australian patients.”

Health Minister Mark Butler referred the ABC’s inquiries to the Therapeutic Goods Administration (TGA), which said the discontinuations were a “high priority”.

The issue was discussed at a medicines shortage action group meeting and the TGA has approved a temporary supply of overseas equivalents for Ordine, Jurnista and Dilaudid.

It said substitutes for Oxynorm, MS Mono and Sevredol were being considered.

“The TGA will meet with affected groups in early 2024 to discuss issues relating to these discontinuations,” it said.

“We are also continuing to discuss longer-term supply of Australian-registered alternatives to these discontinued products with other sponsors.”

It noted there was a $15 million National Reconstruction Fund that could invest in medical science manufacturing if medicines were to be made locally. 

It said it could not force companies to maintain supply, but did have a range of measures that allowed for temporary approval, import and PBS listing of alternate medicines.

Image by jcomp on Freepik.

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