How opioid discontinuations are devastating thousands of cancer and chronic pain patients
Australia is currently grappling with a significant shortage of opioid pain medicines, a crisis that is impacting some of the nation's most vulnerable citizens.
This shortage is due to the discontinuation of more than a dozen types of opioid products in the past year, a move that has drastically limited the options available to doctors for treating their patients.
However, this change might also have enduring and painful implications for certain patient groups.
She relied on the liquid morphine product Ordine for pain relief, but all four strengths of the medicine were discontinued mid-year.
Now, she is about to lose access to their replacements, Sevredol and Oxynorm, after supplier Mundipharma announced that these products would also be discontinued over the next 18 months.
Without these medicines, Claxton says 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.
She recently underwent a five-week hospital stay to manage her pain. If the opioids continue to disappear, Kathy fears she will end up in hospital 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 added.
This discontinuation impacts not only cancer patients like Kathy but also vulnerable individuals experiencing chronic pain who require opioid-based relief.
Previously, it has been reported that one in five Australians live with chronic pain lasting three months or more. Common causes include back and neck pain, headache, and joint pain.
Palliative Care Australia is among health bodies that wrote to Health Minister Mark Butler to raise concerns about ‘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 limited options for thousands of Australians.
Dr Michelle Gold, President of the Australia and New Zealand Society of Palliative Medicine (ANZSPM) finds it hard to understand why the medicines have been discontinued at short notice.
'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.
MundiPharma, which supplies the medicines, said that 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,’ they added.
In response to the crisis, the Therapeutic Goods Administration (TGA) has stated that the discontinuations are a 'high priority'.
At a meeting of the medicines shortage action group, the topic was addressed, and the TGA has authorised a temporary import of foreign substitutes for some of the discontinued medications.
‘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,’ the TGA added.
They also want the government to consider ways to manufacture the medicines locally, considering thatn Australia is among the largest producers of pharmaceutical opioid poppies in the world.
In the meantime, patients and their families are encouraged to speak with their healthcare providers about potential alternatives and to plan for possible disruptions in their pain management.
As we navigate this challenging time, let's remember to support those affected and push for solutions that ensure all Australians can access the pain relief they need.
Have you or a loved one been affected by the opioid discontinuation, members? Share your experiences and thoughts in the comments below.
This shortage is due to the discontinuation of more than a dozen types of opioid products in the past year, a move that has drastically limited the options available to doctors for treating their patients.
However, this change might also have enduring and painful implications for certain patient groups.
The Impact of Opioid Discontinuations
Kathy Claxton, a mother of three, is one of the many affected by this shortage. Four years ago, she lost her pancreas to neuroendocrine cancer and now lives with the pain of neuroendocrine tumours in her liver.She relied on the liquid morphine product Ordine for pain relief, but all four strengths of the medicine were discontinued mid-year.
Now, she is about to lose access to their replacements, Sevredol and Oxynorm, after supplier Mundipharma announced that these products would also be discontinued over the next 18 months.
Without these medicines, Claxton says 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.
She recently underwent a five-week hospital stay to manage her pain. If the opioids continue to disappear, Kathy fears she will end up in hospital 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 added.
This discontinuation impacts not only cancer patients like Kathy but also vulnerable individuals experiencing chronic pain who require opioid-based relief.
Previously, it has been reported that one in five Australians live with chronic pain lasting three months or more. Common causes include back and neck pain, headache, and joint pain.
The Looming 'Health Crisis'
Palliative Care Australia Chief Executive Camilla Rowland warned that a 'health crisis' is looming, with sick children, the dying, and those with chronic pain set to be the most affected.Palliative Care Australia is among health bodies that wrote to Health Minister Mark Butler to raise concerns about ‘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 limited options for thousands of Australians.
The Reasons Behind the Discontinuations
The reasons behind these discontinuations are complex and multifaceted. Some suggested that the medicines are not generating sufficient income for the companies. Others point to the fact that these medications may be coming off patent, making them less profitable.Dr Michelle Gold, President of the Australia and New Zealand Society of Palliative Medicine (ANZSPM) finds it hard to understand why the medicines have been discontinued at short notice.
'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.
Tip
Keep track of medicine shortages and discontinuations on the TGA’s Medicine Shortage Reports Database here.
MundiPharma, which supplies the medicines, said that 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,’ they added.
In response to the crisis, the Therapeutic Goods Administration (TGA) has stated that the discontinuations are a 'high priority'.
At a meeting of the medicines shortage action group, the topic was addressed, and the TGA has authorised a temporary import of foreign substitutes for some of the discontinued medications.
‘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,’ the TGA added.
What Can Be Done?
Health groups have also called on Mr Butler to force pharmaceutical companies to extend notice of discontinuation from 6 months to a year, consult with clinicians, review processes so alternatives can get Pharmaceutical Benefits Scheme (PBS) listing quickly, and proactively look for alternative products.They also want the government to consider ways to manufacture the medicines locally, considering thatn Australia is among the largest producers of pharmaceutical opioid poppies in the world.
In the meantime, patients and their families are encouraged to speak with their healthcare providers about potential alternatives and to plan for possible disruptions in their pain management.
As we navigate this challenging time, let's remember to support those affected and push for solutions that ensure all Australians can access the pain relief they need.
Key Takeaways
- Doctors and pain groups are warning of a health crisis due to the discontinuation of several opioid medicines critical for cancer and chronic pain patients.
- Kathy Claxton, a cancer patient in need of opioids for pain management, is among those affected by the shortage of these essential medicines.
- Health advocacy groups are urging the government to take actions such as requiring longer notice periods for drug discontinuations and considering local manufacture of the medicines.
- The Therapeutic Goods Administration (TGA) recognises the issue as a ‘high priority’ and is working on finding temporary supply solutions and longer-term Australian-registered alternatives.
Have you or a loved one been affected by the opioid discontinuation, members? Share your experiences and thoughts in the comments below.