Morphine Shortage in SA!
Thank you to the POWER FM lunch team for this interview with PALPRAC Chair, Dr Julia Ambler, discussing the lack of availability of morphine. Reminding us that this poses a genuine concern for patients and doctors trying to manage pain.
This conversation was also highlighted on NEWS 24 – insert below,
Access to morphine in the South African healthcare sector remains a concern as availability is under pressure.
Morphine is on the WHO’s List of Essential Medicines and South Africa’s Essential Drugs List. Knysna Sedgefield Hospice, Dr Janet Stanford, said: “We have been facing a human rights crisis for the past three months if we go by the WHO guidelines of a patient’s right to pain relief. Severe pain has a significant impact on quality of life.
It’s also highly distressing to the patient’s family, carers, and healthcare professionals who have to witness people in pain and not be able to do anything for them and not have an answer for families about when the drug will become available.
Stanford said the public sector had been particularly hard hit since the morphine was usually the only drug stocked for severe pain relief at public facilities. Morphine is considered an inexpensive drug at an estimated R60 a gram, and a package of Mist Morph syrup contains 10mg or 5ml with a typical dose of 5ml every four hours or as required.
“In the private sector, there are other strong opioids that are available, but they are expensive and are not in a liquid form, so they’re facing the same challenges,” said Stanford.
“A liquid form of the drug is beneficial when people can’t swallow because it causes them more pain and liquid morphine has a rapid onset of action compared with tablets.”
Dr Margie Venter of non-profit PalPrac (Association of Palliative Care Practitioners of South Africa) said the untenable situation that had unfolded needed to be called out as an “ongoing national crisis”.
“It’s desperate and dire. To allow this suffering to continue without alternatives is not humane,” she added.
Even with Barrs Pharmaceuticals’ response to IPAC that its operations have been restarted, Venter said liquid morphine remained unavailable at the end of September, adding there had also been no communication from the Department of Health on the way forward.
“We have been trying to delve through the supply network to try and find out where the hiccup is – whether it’s a supply issue, whether it’s an issue of non-payment from government, or even if there’s a global shortage, and we cannot get any communication from Barrs or the Department of Health.
We’ve sent enquiries through various channels, and we still don’t have any clarity on the problem. The government has been reticent, which means we don’t know where to focus our attention.
“We can’t plan or start finding solutions, especially in the public sector where there aren’t available alternatives to morphine,” she added.
Venter added that pain management was essential throughout the course of cancer treatment.
“With pain management, some people can function well, maybe even feel strong enough to work, so morphine is not just an end-of-life medication. It’s needed early on as part of cancer pain management.”