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UK Diamorphine Shortage

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UKHRA Statement on the Diamorphine shortage
14th September 2005

Introduction
This is a statement by the UK Harm Reduction Alliance (UKHRA) in response to the current ongoing shortage of diamorphine. UKHRA is an alliance of drugs workers, drugs activists, drug users and ex-users, health professionals and academics. Our website can be found at: www.ukhra.org.

Since the beginning of 2005 there has been a shortage of diamorphine affecting all patients requiring this drug, including those who are prescribed diamorphine maintenance treatment for the treatment of their drug dependence.

Lack of availability of this treatment, which has proven itself to be a highly successful intervention for some, has caused great hardship.

UKHRA calls for a rational, swift response to the problem. In the short term we call for provision to be made for the repackaging and supply of imported diamorphine, or the greater use of other opioids such as morphine sulphate; and in the longer term we call for action to address the deeper underlying issues that have been highlighted by the shortage, including removing the existing duopoly which has proven incapable of maintaining a reliable supply.

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Causes of the shortage
The origins of the shortage, now in its eighth month, lie in the unresolved problems at the Chiron factory in Speke. This resulted in the removal from the market of the provider of 70% of the UK's diamorphine; this shortfall was exacerbated by an unexpectedly low level of stocks held by the other licensed producer CP-Wockhardt.

Whilst the problems at Chiron were unexpected, the way in which the shortfall quickly transformed itself into a full blown catastrophe for many patients reveal a deep seated, wholly avoidable problem in the way in which the NHS procures its diamorphine. It highlights a prioritisation of corporate profits over public health.

The core of the problem is that the NHS is compelled to source its requirements of injectable heroin from a tightly controlled, highly profitable duopoly. A duopoly whose existence is directly incompatible with the provision of a vital drug. The NHS pays some £41.36 per gram for diamorphine, as opposed to the £6.30 (9.45 Euro) paid by the Dutch health service. A further factor that contributes to the inordinately high cost differential between UK and Dutch or Swiss diamorphine lies in the difference in production method used. The only licensed form in which diamorphine can be sold in the UK is the most expensive one namely, freeze-dried amps; in both Holland and Switzerland, however, diamorphine is provided as powder, which can be dissolved for injection as required. When we consider that there is currently a glut in the world market of licit diamorphine such that prices have fallen by 12% in the last year, the government's failure to resolve the current crisis is particularly worthy of condemnation.

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Responses to the problem
The government's actions and pronouncements since the shortfall began to bite have been equivocal at best, impotent at worst. The failure of central government to successfully manage provision is palpable, and makes a prima facie case for another challenge to the cartel.

One of the reasons given for throwing out the last such challenge, in 1995, was that "the importation of narcotic drugs from another member state [of the European Community] would threaten the viability of a sole licensed manufacturer of those drugs in the Member State, and that the reliability of supply of those drugs for medical purposes in that member state would be jeopardized" . In normal circumstances such an argument would seem to be contradictory; in the midst of a wholly artificial shortage, having profoundly deleterious effects on the health and wellbeing of those prescribed diamorphine, the argument is plain obscene.

In their recently published 'Diamorphine Shortage: A briefing for drug treatment service users' the National Treatment Agency (NTA) acknowledge that "there have been concerns that supplies from other countries could have been bought in". Indeed there have . These concerns are given short shrift by the NTA on purely, easily overcome technical grounds, namely that "diamorphine used in Switzerland and the Netherlands is only available as high-dose multi-use vials (e.g. 10g). The department of health has investigated and found that 'multi-dose vials are generally not suitable for use as take home supplies in the UK." To make matters still worse, yet another pharmaceutical company currently holds, and is able to provide, 25g, 5g, and 2g tubs of diamorphine hydrochloride to pharmacists. For those currently suffering this will be an insulting response, and not least of all because according to the NTA "the current situation will continue until at least February 2006".

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Conclusion
UKHRA calls for a rational, swift response to the problem. In the short term we call for provision to be made for the repackaging and supply of imported diamorphine, or the greater use of other opioids such as morphine sulphate; and in the longer term we call for action to address the deeper underlying issues that have been highlighted by the shortage, including removing the existing duopoly which has proven incapable of maintaining a reliable supply.

UKHRA 14th September 2005


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