‘It allowed her to feel at ease’: Fear that dying patients could face greater suffering due to drug shortages

Doctors fear dying patients could face more pain and suffering due to an anticipated shortage of a type of morphine.

A drug called Order, a liquid form of the opioid used to treat severe pain, is expected to be stopped in Australia.

It is given to people dying of cancer and suffering from other life-limiting conditions, including children, to relieve pain and breathing problems.

Several strengths will be discontinued between the end of this year and the beginning of 2024.

Palliative care advocates are calling on the government to find another provider, as well as remove red tape so patients can afford access to them as soon as possible.

Jodi Adams’ baby Cosette was given the drug shortly before she died aged just five last year.

She had very early onset inflammatory bowel disease with combined immune dysfunction and has spent more than half of her life at the Royal Children’s Hospital, Melbourne.

Her mother, 48, from Croydon, said the administration of the drug, which had been discussed with doctors in advance, allowed her daughter to die without suffering.

“Cosette having the oral dose of Order, allowed her to feel comfortable and fall asleep in her final hours before sadly dying peacefully in her sleep,” Adams 9news.com.au.

“If he hadn’t had this drug, it would have been painful for both of us.

“I would like to urge the government to ensure this drug is made available as it is essential and critical pain relief for patients undergoing cancer treatment and end of life care.”

Pediatric palliative care specialist Dr Anthony Herbert, who is also president of Palliative Care Queensland, said the shortage could affect “thousands” of Australians.

He said that while morphine can be given in tablet form, it’s not always suitable.

“One of the challenges is that not all patients can swallow tablets,” Dr Herbert told 9news.com.au.

“Plus a lot of them have feeding tubes.

“We can shatter tablets, but it adds an extra layer of complexity and potential for error.

“The other key thing is that this wording can really help with home care.

“Patients may prefer to be at home rather than in hospital as they approach the end of life.

“This is probably the opioid we have the most experience with for both palliative care and the management of pain related to cancer and other life-limiting conditions, and also for children.

“The concern is that patients may experience more pain, distress or suffering.”

Experts say there have been various supply problems with similar drugs.

“Australia is the second largest producer of raw materials for morphine, but we continue to experience regular supply issues,” said Josh Fear, national policy director at Palliative Care Australia.

“There is an opportunity here to build our sovereign capacity and produce essential medicines here in Australia.

“In the meantime, we look forward to working with the TGA as it works to find a replacement for this essential medicine as quickly as possible.”

The TGA said it was treating the disruption with “high priority”.

“We are also investigating the possibility of future approvals for the import and supply of morphine oral liquids registered overseas under section 19A of the Therapeutic Goods Act 1989.”

A Mundipharma spokeswoman said the order was made by a third party in Australia with Mundipharma holding the marketing authorisation.

He said the organization had decided to stop producing the drug and “sourcing from another manufacturer would not be commercially viable.”

He said stock of the 1mg solution is expected to run out in April 2024.

“We have spent considerable time exploring options with other parties to continue supplying the Order, but despite our best efforts, we have been unable to reach a mutual agreement,” the spokeswoman said.

“We know that this treatment plays an important role in the treatment journey of some patients and we apologize for any concern that this third-party decision may have caused.”

Anyone interested should speak to their doctor.