Doctors are being forced to change the essential palliative care medications they prescribe to patients because of ongoing drug shortages.
Over the past 12 months, at least six essential pain-relieving medications and products have been withdrawn from the Australian market.
This has resulted in doctors needing to change medications to ones that may be less effective, and which may also create risks to patient care due to confusion with the changes for nurses, doctors and community carers including family members.
Despite the situation being known to government since last year, the Australia New Zealand Society of Palliative Medicine said there has been very little evidence of action by the Federal Government to address the situation.
“Patients who are reaching the end of their life are suffering additional distress and uncertainty due to the ongoing shortage of morphine-based medicines in Australia” says Dr Michelle Gold, President of the ANZSPM and Director of Palliative Medicine at the Alfred Hospital in Melbourne.
“We have been alerting the TGA and the Minister of this looming crisis for close to a year now. We have written directly to the Minister and the TGA and we have had meetings with department officials. While the TGA are doing what they can to inform the professions and the public, they are not responsible for ensuring supply of these much-needed medicines.
“The regulations and government policy surrounding the supply of essential medicines is complex, but at the end of the day it is extremely frustrating that essential morphine-based medicines which we prescribe daily in Palliative Medicine, are in such short supply or not available at all and that we are being forced to use medicines or products which not only results in less effective pain relief, but may lead to unwanted side effects.”
Dr Gold says the situation was worse in the private and rural and remote settings where the processes for local pharmacists to access medicines from the S19A list, is more complex and costs could be prohibitive.
“‘If a medicine is listed under s19A as being a substitute for the PBS listed medicine, this alternative may very well not have PBS listing, so that medicine is very expensive. For example, morphine liquid can be up to ten times more expensive.
For example, previously, a pack of 100 x 32mg tablets of Hydromorphone SR (slow release) would be $182. This has been removed from the market and the overseas alternative is $4209 for 100 tablets, or 23 times more expensive.
ANZSPM wants to see PBS listing for all substitute medicines.
“We are unsure of the barriers that lead to this inequity in end-of-life treatment across the public, private and community sectors, but it is unacceptable and is something the government should address,” Dr Gold said.
The Government is currently seeking advice for an upcoming medicines shortage reform process, as some changes lie outside the TGA powers and relate to existing shortcomings in legislation and government policy.
“We shall be advocating for these changes and hoping that steps are taken to secure our nation’s supply of essential pain-relieving medicines in the future. Patients receiving end-of-life care deserve better than what we can offer today.”