Diamorphine/Morphine National Shortage
The MMT has been made aware that there are national shortages of injectable diamorphine and morphine, with all pharmacy contractors and wholesalers affected to varying degrees. To minimise the difficulty in obtaining parenteral opioids for palliative care, please can prescribers and dispensers work together as described below.
· Whenever possible, prescribe in anticipation of need, allowing sufficient time for the patient / carers to obtain medicines from their usual pharmacy through the normal supply chain (which may be next-day supply).
· Prescribers are asked to liaise with local community pharmacies to determine what stocks of injectable opioids are available to prescribe. Some pharmacies may have some strengths of diamorphine available, others may only have stocks of alternative medicines (e.g. injectable morphine). Prescribers and dispensers will need to work together to make the most appropriate decisions for patients while these shortages continue.
· Please prescribe each palliative care item on a separate prescription form in case different pharmacies need to dispense them.
· All pharmacies providing the Think Pharmacy Urgent Palliative Care Medicines Service are being asked to review their stock holding. If unable to obtain diamorphine as per the formulary stock holding, we are asking them to obtain morphine sulfate 10mg/1ml solution for injection (10 ampoules) and Morphine sulfate 15mg/1ml solution for injection (10 ampoules).
· Selected pharmacies in each CCG have also been asked to obtain a supply of oxycodone injection for patients with a specific clinical need (e.g. impaired renal function or CNS side effects with other injectable opioids). The selected pharmacies are: Asda Pharmacy, Crewe; Lloyds Pharmacy in Sainsbury’s, Cumberland street, Macclesfield; and Boots, Witton Street in Northwich. These pharmacies are open during the Christmas and New Year Bank holidays (see the published rotas at http://www.cpcw.org.uk/pharmacies-in-the-cpcw-footprint/ ). The pharmacies have been requested to obtain stocks of oxycodone 10mg/1ml solution for injection (5 ampoules) and oxycodone 50mg/1ml solution for injection (5 ampoules). Prescribers and pharmacies may need to be aware of this arrangement to refer patients / carers onwards to a pharmacy with stock.
· Local hospices may be contacted for advice: St Lukes (Winsford) phone 01606 555489 and East Cheshire Hospice (Macclesfield) phone 01625 666999.
· In exceptional circumstances when community pharmacies have exhausted all other avenues to obtain supplies, local Acute Trusts may be able to provide some support. Please phone Mid Cheshire Hospitals NHS Trust pharmacy on 01270 612260 or East Cheshire Trust pharmacy on 01625 661 266 for further information.
I am sorry for the brevity of this information – it is not possible to map the changing stock holdings across the patch and it is important to highlight the issue so that local liaison can take place to support patients, particularly around this period of extra pressure in the system because of the holidays.