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Lessons from the UK diamorphine shortage

Published online by Cambridge University Press:  02 January 2018

Rupert White
Affiliation:
Cornwall Drug and Alcohol Team, Tolvean House, Redruth, Cornwall TR15 2SF
David Cox
Affiliation:
Cornwall Drug and Alcohol Team, Tolvean House, Redruth, Cornwall TR15 2SF
Ben Charnaud
Affiliation:
Cornwall Drug and Alcohol Team, Tolvean House, Redruth, Cornwall TR15 2SF
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Abstract

Type
The columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 2005. The Royal College of Psychiatrists

The article by Luty (Reference Luty2005), together with the two commentaries (Reference CarnwathCarnwath, 2005; Reference GilvarryGilvarry, 2005), does much to reveal the intricacies of the debate concerning injectable diamorphine prescribing. Unfortunately, none of the articles mentions the fact that since December 2004 supplies of injectable diamorphine in the UK have been diverted away from addiction services due to a failure in production at the plant of the main manufacturer: Chiron.

In Cornwall we had 51 clients in receipt of such a prescription, all of whom had already been tried on optimised methadone maintenance, and two-thirds of whom were stable and not using street drugs. When the shortage started to affect our local pharmacies, 43 of these clients were converted to a part-injectable methadone prescription. All 43 complained of side-effects and, using a questionnaire, keyworkers identified other ‘serious undesirable consequences’ in 41, with 35 clients admitting to increasing or restarting street heroin use. Clients who were not switched to methadone had diamorphine solution or tablets, or higher strength ampoules, which were on the whole much better tolerated.

The experience has confirmed to local clinicians the value of diamorphine by whatever route, particularly in those that do not tolerate methadone well.

The disruption that has been caused by the supply failure has been considerable and we have been disappointed that the Department of Health appears to have had so much difficulty in procuring adequate additional supplies, or even in giving a reliable date as to when normal supplies will return. This uncertainty is adding considerably to the ongoing difficulty of planning safe and effective treatment for our clients.

References

Carnwath, T. (2005) Heroin prescription: a limited but valuable role. Psychiatric Bulletin, 29, 126127.Google Scholar
Gilvarry, E. (2005) Commentary on: New guidelines for prescribing injectable heroin in opiate addiction. Psychiatric Bulletin, 29, 128130.Google Scholar
Luty, J. (2005) New guidelines for prescribing injectable heroin for opiate addiction. Psychiatric Bulletin, 29, 123125.Google Scholar
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