Durban - Cancer patients and other chronic pain sufferers are in for a rough ride as stocks of well-known analgesics and several other essential drugs run low in the private and government sectors around the country.
The shortage of morphine powder in particular has been red-flagged by medical and pharmaceutical health professionals as a major concern with one organisation saying pharmacists were “scrambling” to find stocks.
They say the morphine powder is used to create a syrup and plays a key role in pain control, especially in the treatment of children with severe pain and patients receiving palliative care.
The list of shortages includes drugs used for mild or moderate pain like Betagesic and Napamol, as well as Ponstan paediatric suppositories, low dosage Panamor suppositories, pain patches and opioids like Targinact, which is used in the treatment of severe pain.
Independent on Saturday is also in possession of a list released by the Government Employees Medical Scheme, dated September 1, which indicates that there are shortages of almost 150 other essential medications, including some dosages of Metformin that is used in the treatment of diabetes, as well as medication for depression and other psychiatric illnesses.
The Independent Community Pharmacist Association (ICPA) said there were some shortages in the country that could perhaps be linked to the after effects of the Covid-19 pandemic.
The ICPA, which represents the interests of at least 1 200 independent community pharmacy owners in South Africa, said 80% of the active pharmaceutical ingredients needed in the country were sourced from abroad.
However, the current drug shortages were not unique to South Africa.
ICPA CEO Jackie Maimin also raised concern about the shortage of morphine powder, which has been in short supply for at least two months.
“Pharmacies are scrambling and borrowing from each other,” she said.
Maimin said the list of drug shortages included some anti-hypertensive medications. Where possible, generic medicines were prescribed, but they found that some drugs were completely unavailable and alternatives were not always the best solution.
“Any change to medication can take two to three months to stabilise, so we never want to just change,” she said.
In the case where there were no stocks of morphine powder she said morphine tablets or injectables could be used but not all patients were able to swallow tablets and pain patches were not cost-effective.
She also raised concern about the ongoing shortage of injectable contraceptives, saying it was difficult to get women to switch to the pill because it had to be taken consistently.
The Association of Palliative Care Practitioners of South Africa (Palprac) says morphine powder is the most commonly prescribed drug in palliative care.
Palprac is a non-profit organisation consisting of various medical professionals who offer specialised care to people with serious illnesses.
Palprac chairperson Dr Julia Ambler said patients in the private sector had more options than state patients, but even then it was disruptive to change their treatment.
In addition, even those with medical aid could not necessarily afford alternative medication because the costs were prohibitive or were not covered by their schemes.
“For a lot of patients it’s meant chasing around, phoning every pharmacy and a lot of patients have missed doses and really found themselves in a lot of pain,” said Ambler.
She said the morphine powder was made into a short-acting syrup that lasted for four hours and its onset was quite quick, within half an hour, and that it was considered the gold standard of treatment.
“Some children are on small doses so only the powder can be used because the other doses are too big. If we can't get it then we are really stuck.”
Ambler said palliative care was not only for end-of-life care, but also for those with conditions that would shorten their lives but were not dying, like those with slow- spreading cancers. Patients with motor neuron disease and neurological conditions lived with their pain and conditions for many years.
Ambler stressed that the morphine powder shortage would be felt widely because it was the most commonly prescribed for strong pain and was used across the board for every kind of pain.
“Morphine, why it’s so useful is that you can adjust the dose upward as long as you do it carefully and in a planned way; you can give as much as the patient needs.”
She said the social media groups she was on seemed to believe the shortage was caused by a production problem.
Senior pharmacology lecturer Andy Gray said South Africa was dependent on one supplier of morphine powder, in Cape Town, which had just received stock and that the problem was almost solved.
He said the shortage of drugs was a global problem that was serious and difficult to address.
The US Food and Drug Administration regularly printed lists of drugs that were out of stock, in Europe that information was available on websites, while in Canada the industry paid for updates.
“Our difficulty is that we don’t have a reporting system so we don’t know what is out of stock, when, for how long and for what reasons. That’s really debilitating,” said Gray.
He said there was no legal requirement to report stock-outs in South Africa and no one had taken responsibility for it.
One of the reasons for shortages was the over-consolidation of the active ingredients market, said Gray.
He said the active ingredients for older drugs were increasingly made in China and India so regardless of where the final factory was based, if one of those countries had a problem it had ripple effects around the world.
Previously, the Chinese government’s decision to close down factories to improve air quality ahead of the Beijing Olympics led to shortages, while India also caused stock- outs when it blocked exports because of the Covid-19 pandemic.
Referring to the shortage of contraceptives, Gray said the South African government relied on a single manufacturer and when it decided to stop production other manufacturers could not meet demand.
Stavros Nicolaou, the head of the Pharmaceutical Task Group that represents 90% of the industry in the country, said they had not yet seen any shortages.
However, there was an increase in logistics and inbound costs and price adjustments were inevitable.
It was not yet known when the increases would come into effect and how big they would be.
Pharmaceutical group Clicks’ chief healthcare officer, Rachel Wrigglesworth said they had not experienced any shortages, “nor had any of our manufacturers advised us of any availability issues”.
The Department of Health failed to respond to specific questions about pharmaceutical shortages. Instead it reissued a statement from earlier this week in which it said there were no known shortages of contraceptives.
It said that a decision-making forum that included all the provinces was set up to address medicine supply challenges, improve medicine availability and reduce the potential impact of stock-outs.
The Independent on Saturday