In a joint statement last month, the NHS Specialist Pharmacy Service (SPS) and UK Medicines Information (UKMI) warned healthcare professionals that Accord – one of only two companies that produce diamorphine 5mg and 10mg injections in the UK – “are experiencing issues” at their manufacturing site.

The same month, NHS England warned patients that the only other supplier of the palliative care drug – Wockhardt – is “unable to produce extra stocks” of the product “at short notice”.

“However, the Department of Health and Social Care (DH) is working with them to see how quickly they can produce more of the drug,” it added.

Return to full capacity expected next year

Accord told C+D yesterday (June 18) that it does not expect to have an “increased supply” of these lower strengths until September, and will not be “back at full capacity” until “early 2019”.

“The production of diamorphine is a complex process and we are working closely with the Medicines and Healthcare products Regulatory Agency, the DH and our manufacturer to rectify the current situation,” it added.

Accord would not clarify to C+D the issues that had hampered production of the drug.

What should healthcare professionals do?

In its joint statement, the SPS and the UKMI stressed there have “not been issues with availability” of 100mg and 500mg strengths of the injection.

“Previous shortages of diamorphine injections forced prescribers to find alternatives, such as morphine sulphate,” the organisations pointed out, “and many areas continued to use morphine after the original shortage had resolved”.

“Nice guidance on the effective prescribing of strong opioids for pain in palliative care recommends initiating subcutaneous opioids with the lowest acquisition cost.”

“Teams providing palliative care for patients in the community who are still using diamorphine should seek advice from their local palliative care network on use of an alternative regimen should a shortage arise,” they added.

“Patients in drug addiction treatment programmes may experience difficulties switching to alternatives and the community drug and alcohol team should be contacted for advice.”

Read the organisations’ memo in full here.