Diamorphine shortage could be more than just a problem for drug addicts

The UK has experienced many shortages of essential medicines, particularly since the start of the pandemic. The latest shortage is diamorphine, a painkiller that can be prescribed to drug addicts who have not responded well to other treatments.

With only around 200 people in England being prescribed diamorphine as a drug treatment, these shortages could have dire consequences for those who depend on it to help them lead normal lives, get jobs and be part of society. the society.

Diamorphine is also used as an analgesic in surgery and even for severe cancer pain. As a result, these current shortages could affect thousands of people in the UK.

The shortage also highlights a bigger problem affecting people in the UK and around the world when it comes to being able to access essential medicines.

Understanding shortages

While diamorphine (laboratory-made heroin) is used as a painkiller, Britain was the first country in the world to prescribe it to street heroin users as a treatment for opioid addiction. In most countries, the medical use of diamorphine is prohibited due to the risks and potential for abuse. It is illegal to use or sell in the United States.

While most street heroin users will be offered oral methadone or buprenorphine as substitutes, diamorphine is offered when these substitutes are ineffective. UK-based programs that help drug users access products such as diamorphine have seen a drop in drug-related crimes and deaths. But for the small number of diamorphine users in the UK, when this treatment is unavailable it could lead to a relapse, putting them at risk if they turn to street heroin.

This is not the first time there has been a shortage of diamorphine in the UK. In 2021, supply shortages forced some NHS trusts to buy more expensive pre-filled vials of the drug for patients. This is one of the reasons why morphine is now recommended for pain relief, because it is cheaper and there is more supply. However, morphine is not authorized for use in drug addiction.

Diamorphine shortages worsened in March 2022. The main reason for this is that England depends on two main suppliers – Wockhardt and Accord Healthcare, generic drug makers who both have bases in India – who are experiencing stock problems . In fact, this product had intermittent availability issues as early as 2004 that have not been resolved. Manufacturing issues have been cited as the source of some of these issues.

In January 2022, the 5mg and 10mg vials were reported as unavailable, fearing that demand for other strengths (such as 30mg vials) could lead to further shortages. This is now the case, with injections of diamorphine in varying concentrations sold out in England.

Five 5 mg vials of diamorphine wrapped in plastic.
Many diamorphine dosages are now experiencing shortages.
NSnap/ Alamy Stock Photo

Northern Ireland also reported supply shortages. But Scotland has not reported any shortages – likely because it is sourcing from a source in Switzerland, which is also used by a clinic in England. Wales has also not experienced a supply disruption, as the use of diamorphine is extremely limited and other drugs are prescribed to recover heroin addicts.

Looking forward

Supply shortages primarily affect people who use single-use vials of diamorphine at home, including former heroin users and hospice patients.

Alternative drugs are available for most patients, such as morphine in cancer care. GPs and healthcare workers are advised to encourage patients to use other drugs where the supply is more stable. But for recovering heroin users who haven’t had success on methadone or buprenorphine, diamorphine may be their only option. This is why decisions about treatment changes should be made with patients rather than for them.

Hospitals, hospices and hospice teams have already stopped using diamorphine, and newly referred street heroin users are instead being prescribed a different treatment to help them. This means that shortages will likely only be a significant problem for people who have already been prescribed diamorphine.

It is unclear how the current shortages can be reduced or if other companies wish to manufacture this product for the UK market. But to mitigate its impact and avoid such a situation in the future, the following actions should be considered:

  1. Move on to the alternatives. A recent study claims that other products may be successful in helping patients with opiate addiction. But again, if a patient is already taking diamorphine, they should be carefully consulted on decisions to change their treatment.

  2. Responsible prescribing. This means not prescribing opioids, such as diamorphine, unnecessarily (as for chronic pain) because there is a risk of becoming addicted.

  3. Reduce overreliance on a few sources. The UK is heavily dependent on India and China for the supply of many drugs – not just diamorphine. Developing manufacturing capacity in the UK or sourcing from other countries should make the drugs more accessible.

While diamorphine shortages may only affect a small segment of the UK population, it highlights the wider shortage of drug supply that the UK has experienced for years – which has only made only get worse as a result of Brexit and the pandemic. The war in Ukraine can only further contribute to drug shortages. That’s why the UK government needs to find other ways to get essential medicines to the people and invest more in UK manufacturing capacity to make sure this doesn’t happen – or at least happens less. often.

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