Medicine shortages in Australia have reached an unprecedented level in recent months, particularly in remote and regional WA. How are people coping and what can we expect going forward?
By Suzanne Harrison
Pharmacist Ben Teo and his family have run the community pharmacy in Karratha for several years. Prior to that they ran a pharmacy in Carnarvon for seven years.
They love living in the far north of Western Australia, but lately doing his job has proved challenging. Unprecedented medication shortages across the country have proved difficult to manage for doctors, pharmacists and patients.
“I guess it started around COVID. I’d like to say it has got a bit better, but it’s still a daily draining task,” Mr Teo said of the shortages.
“We have one staff member sitting on the computer just to keep updated.”
Mr Teo says these shortages are the worst he has ever seen in his time as a pharmacist. Some, he explains, are quite simple in that it’s just a phone call to get a substitute and that is doubled up for the short term.
But with ADHD or diabetes medicines, it’s not that simple.
“They will potentially have to go back to the GP for monitoring and ongoing intervention, which then puts more pressure on the whole health system.”
Therein lies the nub – the entire health system, patients and the economics of the structure have been affected, resulting in an Australia-wide cry for better management and communication of potential shortages.
There are currently more than 400 medicine shortages across the country, according to the Therapeutic Goods Association (TGA) as well as a worldwide shortage reported by the World Health Organization.
In Australia the list of shortages includes pain management medications, some antibiotics and diabetes medications.
Supply of hormone replacement therapy estradiol-containing transdermal patches is also impacted, with pharmacists able to dispense an alternative brand or strength as of November 2024 as the TGA looks to mitigate shortages.
As a result, there have been calls for a more streamlined approach to dealing with these shortages in Australia in the hope it prevents similar long-term shortages in the future.
Managing the problem
The TGA said late last year it was “pursuing a program of regulatory, digital and process improvements to address high priority issues and further reduce the impact of medicine supply disruptions”.
In June 2024 the TGA held discussions to identify priority areas for potential reform, which were provided to the Federal Government.
In November it announced proposed improvements to its monitoring and management of medicine shortages and discontinuations.
But in January this year the Australian Medical Association (AMA) called for a dedicated forum to provide ongoing advice and solutions.
Calls for a national forum
AMA National President Dr Danielle McMullen said such a forum could significantly improve communication to doctors, patients and all other relevant stakeholders.
“One issue that persists is the challenge of timely, accurate and consistent communication regarding medicine shortages. These shortages affect so many people in our community, including doctors, pharmacists and, crucially, patients.
“Medicine shortages and other disruptions have a profound effect on the community and inadequate communication can result in additional costs for patients, for whom there is often little transparency or forewarning.
“We appreciate the nature of medicine shortages are unpredictable, but this is about giving us the best possible chance to respond to supply disruptions, which remain prevalent in the post-COVID era.”
Speaking to Medical Forum, Dr McMullen said the proposed forum is a way to improve transparency and awareness of mechanisms that help manage shortages.
“A forum of stakeholders would help make sure that the whole sector is on the same page, both about existing shortages and looking forward, because sometimes they can predict those,” Dr McMullen said.
To some extent, medicine shortages or delays are expected, partly due to raw material shortages and fluctuations in demand. But the ‘why’ of recent shortages, their length and breadth is a complicated answer.
According to Diabetes WA the global shortage of Ozempic started in 2022. There are several factors that contribute to a disruption in the supply of medications, these include:
- disruptions in the manufacturing plants
- change in demand due to changes in health practitioner clinical practice guidelines
- shortage of raw ingredients
- discontinuation
- natural disasters
- local or international challenges in manufacture and or transportation
- product recalls due to unexpected quality and safety issues.
In light of the pressure this is placing on healthcare providers, and of course patients, the TGA and other groups have scrambled to find a way to improve and avoid.
In April 2024, the TGA released a research report entitled Understanding the Medicine Shortages in Australia.
Insights found that in some cases it was “too little too late” and that “consumers have been left to find solutions themselves”.
Solutions ranged from considering ways to increase production and supply of medicines to Australia through on-shore manufacturing; partnering with overseas allies for stock exchanges; ensuring equitable distribution and allocation of stock across the country; and implementing purchase limits to ensure fair distribution.
Progress is slow moving. To mitigate a national shortage of IV fluids the Federal Government in March struck a $40m deal with Baxter Healthcare to expand their production facility in Sydney – $20m in federal funding will be matched by the company.
A long way to go
While there have been positive steps, one particularly worrying impact is on palliative care which has faced dire shortages in the past 12 months.
RELATED: Calls to address palliative care meds shortage
For 60-year-old Linda Summerton, the experience of trying to find suitable end-of-life medicine for her 86-year-old mother was devastating.
Diagnosed in 2019 with pulmonary fibrosis, her mother – who is still alive – was relatively stable until she started suffering from shortness of breath in 2023.
In 2024 her mother started using Ordine – liquid morphine – for the pain every day.
“It got to July, August, and we went to the chemist to fill it and they said ‘We don’t have any’,” says Linda, a palliative care nurse for 22 years.
They were told there were no alternatives, so they went back to their GP and were given a script for Oxycodone.
“Most people know that morphine is the gold standard for pain and shortness of breath, but mum started on the Oxy. She said it wasn’t as effective.”
This lasted three months.
“One day I rang eight different pharmacies trying to find Ordine,” Linda adds.
Finally, around September, they were able to access the drug.
“I felt like I had won the lottery,” Linda says. “My mum is in a wheelchair so going back and forward to the GP made the entire experience even more difficult.”
Being a nurse, Linda had heard about the coming shortages, but she says they were told alternative brands would be available.
“This is a drug that’s mainly for palliative care patients and end-of-life patients. It’s not a time when you want more uncertainty, there’s enough uncertainty. I’ve never known a shortage like that before.”
Pressure on hospitals
Dr Peter Allcroft, Chair of Palliative Care Australia, has suggested people are ending up in hospital as a result of being unable to access pain medicines.
Despite sector representations to the Minister for Health, the TGA and the Department of Health and Aged Care, there has been little progress toward ensuring a stable supply of these life-changing drugs, PCA said in a statement.
“People, including children, are dying without adequate pain relief,” Dr Allcroft says.
The current situation has been building over several years and has become especially challenging in the last 12 months as global supply chains and pharmaceutical companies falter and reprioritise.
Adding to the distress is cost, with many of the alternative medications not subsidised through the Pharmaceutical Benefits Scheme (PBS).
One of the most startling examples is hydromorphone SR, a medication used to treat acute and chronic pain, which costs the public $182 for 32mg. The overseas alternative, which is not PBS-listed, is $4209 for 100 tablets – 23 times more expensive.
RELATED: IV fluid shortage drags on
Dr Meera Agar, PCA Board Chair, tells Medical Forum they first heard certain medications would be discontinued 18 months ago, with only a couple of months’ notice.
“We’ve been working closely with the medical shortages section of the TGA… but that’s not the end of the story,” she says.
The next questions are around what medication replaces that? And what about clinicians who need to explain how to use the new formulation?
“The flow on parts have not really been tackled,” Dr Agar says. “So that’s a more immediate issue.
“There’s a resource issue but also access to a clinician who can prescribe it, to actually finding stock.
“It’s that whole pathway. Then the next script you’ve got to do it again because you can’t guarantee that once you’ve been on the replacement it’s going to be available for your next month’s script.”
Fixing the issue
Also at the frontline of the shortages are pharmacists. Andrew Ngeow, WA Branch President of the Pharmacy Guild of Australia, has some inciteful views on how to ease the pressure.
Mr Ngeow says 90% of Australian medicine is imported and, on top of that, there’s the tyranny of distance, particularly in WA.
“We are the largest health jurisdiction in the world,” Mr Ngeow told Medical Forum. “We have a low population density, and we are at the end of a complex worldwide supply train.
“So shortages will be felt disproportionately in WA compared to anywhere else in the world.”
He explains there were issues during COVID and “I don’t think we’ve ever really seen a catch-up from that point”.
RELATED: More pain meds shortages
Due to the pressure of shortages, pharmacists are working harder than ever, he says.
“It’s that extra thing they need to handle. They are just doing more in general.”
Going forward, Mr Ngeow says there’s a lot more that can be done if “we can get some small regulatory changes in the State”.
With pressure on GPs and organisations saying there is no end in sight to the medication shortages in the short to medium-term, he believes pharmacists should be given the power to make decisions on prescriptions to help ease the pressure where it is safe to do so.
RELATED: ‘Dr Pharmacist’ gets the green light
“For example, if you can’t get a 20mg tablet, a pharmacist should be able to give you two 10mg tablets,” Mr Ngeow said, adding that the Guild has spoken to departments and government on this subject.
“We will see where that lands. Hopefully sooner rather than later.”
Pressure on GPs
What about the GPs themselves? Dr McMullen says going forward the right mechanisms need to be in place to communicate these shortages well ahead of time and secure alternative suppliers.
“Having that clear signalling helps. If you know it’s only going to be a shortage for a month – there’s probably some people who can hold out. We can use existing supplies if it’s going to be 12 months, then you can probably change people to a different medicine. So, it’s really understanding the recommended action as well as what’s happening in more detail.”
Dr McMullen knows this first-hand; she’s a GP and describes the shortages as “endlessly frustrating”.
“We get feedback from AMA members about having to double check another system all the time. You get phone calls back from frustrated patients.”
It seems that the ‘why’ of how it came to this is multi-layered and complex, with much out of Australia’s control.
However, information sharing and greater awareness of existing and forecasted supply disruptions can be improved.
The Pharmacy Guild of Australia has called on the Federal Government to reinstate the Medicine Shortage Working Party, which was disbanded in 2021.
The current approach to managing medicine shortages is too short-term and reactive, says National President of the Pharmacy Guild, Trent Twomey.
“It doesn’t address the root cause of shortages, and patients continue to suffer. Information sharing and greater awareness of existing and forecasted supply disruptions is crucial to making sure Australian patients have the medicine they need.”
As Linda Summerton says of her mother’s experience: “I knew morphine shortages were coming, but there was not enough planning or foresight. It should never have happened, we’re talking about elderly people at the end of their life.”
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