Australian hospitals are being forced to ration a painkiller used in millions of operations each year because a major supplier cannot keep up with demand.
The shortage of the powerful painkiller fentanyl could potentially endanger patients, experts say, and is one of a growing number of critical shortages being reported across the nation, including for first-line antibiotics and chemotherapy drugs.
The problem has prompted calls for an overhaul of the way drugs are supplied to Australia, to prevent single pharmaceutical companies holding near monopolies over important products.
Fentanyl is a potent but short-acting painkiller used in most anaesthetic procedures, including heart surgery.
Doctors and pharmacists warn the ongoing shortage is putting huge pressure on the health system, as alternative drugs can be expensive and difficult to source, and staff may make mistakes using replacement drugs they are not familiar with.
“Just about everyone that has some sort of operation is going to receive fentanyl for their pain,” said Dr Lisa Pont, a pharmacist and senior research fellow at Macquarie University.
“It’s a pretty fundamental medication.”
Aspen Pharmacare is a major supplier of fentanyl in hospitals in Australia, and holds the contract to supply fentanyl to Victorian public hospitals.
The company reported an Australia-wide shortage of fentanyl citrate at the end of May and the shortage is likely to continue until at least the end of the month, according to the Therapeutic Goods Administration.
Days after Aspen’s shortage was declared, other manufacturers started reporting their own supply problems citing “unexpected increase in demand”.
Aspen’s fentanyl citrate is manufactured in Spain by a third party. An Aspen Pharmacare spokeswoman said because of this third-party arrangement, stock and timing of deliveries were “beyond Aspen’s control”.
The spokeswoman would not say how many contracts the company held to supply fentanyl for Australian hospitals, saying that information was “commercial in confidence”.
NSW Health also declined to reveal details of its fentanyl supply arrangements but noted that “the fentanyl shortage is due to manufacturing issues relating to a particular brand”.
“Hospitals have reserved available stock for situations where fentanyl is the only suitable option until normal supply is reinstated,” the spokesperson said.
It’s understood similar rationing is occurring at hospitals across the nation, including at The Alfred in Melbourne, where staff are using alternative drugs where possible.
Professor David Scott, the president of the Australian and New Zealand College of Anaesthetists, said the fentanyl shortage should be a warning about Australia’s precarious drug supply chains.
He said when big contracts were given to a single supplier, hospitals became vulnerable to worldwide shortages or unexpected events such as a factory fire.
“Why would a whole state or even the whole side of the country go with one supplier for a particular critical drug? They should have at least two suppliers,” said Professor Scott.
Professor Scott, who is also the director of anaesthesia and acute pain medicine at St Vincent’s Hospital in Melbourne, suggested tax incentives should be given for companies to manufacture critical drugs in Australia.
Professor Michael Dooley, president of the Society of Hospital Pharmacists of Australia, said there was a risk that people could make mistakes while using replacement medications they were not familiar with.
Professor Dooley said the medicine shortages in Australia appeared to be getting worse, with a recent survey of hospital pharmacists finding 150 shortages of different medicines on a single day in April.
Almost 7 per cent of those medications had no alternatives.
“I think there would be without doubt times where shortages of medications would put patients at significant risk,” Professor Dooley said.
Professor Philip Clarke, director of the Centre for Health Policy at the University of Melbourne, said Australia should consider following in the steps of New Zealand, by penalising pharmaceutical companies that sign contracts to supply critical drugs, but fail to meet those obligations.
“For counties such as Australia and New Zealand that are relatively small compared with the world market, such contracts are one of the few ways to ensure ongoing supply of important medications,” Professor Clarke said.
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