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InvisibleveggieM

Registered: 07/26/04
Posts: 15,835
[UK] Diamorphine shortage causing former heroin users to relapse for first time in a decade
    #27828394 - 06/20/22 10:43 AM (5 days, 11 hours ago)

Diamorphine shortage causing former heroin users to relapse for first time in a decade, charities warn
June 17, 2022 - The Pharmaceutical Journal

With all strengths of diamorphine injections currently out of stock, charities have said patients are returning to using heroin.

Patients who have used diamorphine as a substitute for heroin are now relapsing because of a national shortage, charities have warned.

The Department of Health and Social Care (DHSC) confirmed that 5mg, 30mg, 100mg and 500mg injections of diamorphine are currently out of stock.

Clinicians have been advised to switch patients to alternative opioids, but experts warned this was often not an option for patients who had been stable on diamorphine for years because of their addiction.

Claire Robbins, advocate and drugs adviser at the charity Release, told The Pharmaceutical Journal that pharmacists were distressed after seeing patients they had known for 10 or 15 years deteriorate because they could not get the medicine they needed.

While there have been periodic shortages of diamorphine for some time, currently there is no stock anywhere, and it is thought that up to 200 people may be affected.

“There is nothing that matches up to diamorphine; there are alternatives but they don’t really work,” Robbins said.

“These are patients that have been on prescriptions for 20 years and have been very stable and working, living their lives, and are closely monitored to ensure they’re not on other drugs.

“The majority we are supporting at the moment have now relapsed, often for the first time in 10 or 15 years and that’s really devastating for them,” she said.

“These people have built relationships with their pharmacists over 10 to 15 years and I’ve had pharmacists on the phone who are quite distressed about seeing their patient deteriorate.”

Roz Gittins, director of pharmacy at charity Humankind, said: “The shortage has left treatment providers in really difficult situations and has put some of our most vulnerable people at risk without the medication they have been stable on — with all the associated risks that come with this, such as a potentially fatal opioid overdose should they lapse.

“Whilst organisations are doing what they can to look at alternatives, it inevitably causes significant anxiety for all concerned.”

Rachel Britton, director of pharmacy at the addiction charity With You, said: “We are concerned about the short supply of diamorphine by injection, especially for people who have exhausted all other treatment options for their issues with heroin”. 

A DHSC spokesperson said they were aware of an ongoing issue with diamorphine injections.

“We want to reassure patients that alternative opioid products, including all other forms of morphine, remain available and if they have any concerns, they should speak to their prescriber or pharmacist.

“We are working with suppliers to manage the issue, and with NHS England and national experts on advice for healthcare professionals regarding alternative treatments and affected patients.”

There are two suppliers [of diamorphine] in the UK — Wockhardt and Accord — and the DHSC said the supply chain had been unstable since March 2020.

It is expected that some stock of diamorphine 5mg injection is due to become available later in June 2022 and further diamorphine 30mg injections will be available during July 2022. The 100mg injection is also expected back in stock later in June 2022.

A spokesperson for Accord Healthcare said the issue was “realising the raw material into its finished dosage form”. 

“As the UK’s largest volume supplier of generic medicines, we take our responsibility very seriously and we have been working closely with the Medicines and Healthcare products Regulatory Agency (MHRA) and the Department of Health and Social Care, keeping them regularly informed of our stock situation,” they said.

“We are currently out of stock of 100mg [diamorphine injections] and are fully committed to working with the MHRA to test and release our next batch as soon as possible, whilst keeping our key stakeholders and customers informed of our progress as necessary.”


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InvisibleRotnpinsS
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Registered: 01/11/22
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Re: [UK] Diamorphine shortage causing former heroin users to relapse for first time in a decade [Re: veggie]
    #27828468 - 06/20/22 11:57 AM (5 days, 10 hours ago)

This is very unfortunate... I can't even imagine being stuck in that situation.. I know that they mention alternatives. Does anyone know if they could at least try switching to methadone treatment?


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OfflineTheShroomanizer
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Registered: 06/12/09
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Re: [UK] Diamorphine shortage causing former heroin users to relapse for first time in a decade [Re: Rotnpins]
    #27828653 - 06/20/22 02:41 PM (5 days, 7 hours ago)

I’m sure that there are plenty of substitute opiates that they could use to prevent withdrawal symptoms, however I believe the problem they are experiencing is that these people were “stable” and being successfully treated with a maintenance dose of 2A-Morphine. The risk now is that switching all these people up will throw the Ballance off, and inevitably some people will revert back to street drugs which are always more risky....as for preventing withdrawals, there are tons of long lasting and potent opiates to saturate the receptors.


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InvisibleRotnpinsS
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Registered: 01/11/22
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Re: [UK] Diamorphine shortage causing former heroin users to relapse for first time in a decade [Re: veggie]
    #27828715 - 06/20/22 03:25 PM (5 days, 6 hours ago)

Yeah, makes sense. I think most methadone treatment clinics start at 30mg, so if they don't make an exception and start people on a higher dose to try and match their therapeutic dose I could definitely see it causing issues.

It's an unfortunate situation, for sure.


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InvisibleElVatoFirme
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Registered: 11/14/10
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Re: [UK] Diamorphine shortage causing former heroin users to relapse for first time in a decade [Re: Rotnpins]
    #27828771 - 06/20/22 03:55 PM (5 days, 6 hours ago)

The shortage, though an issue, is not the issue. This event is shedding light on the actual inefficiency of maintenance clinics. All that work staving off withdrawal isn't resolving the underlying issue of physical, and often times mental, addiction. These are clinics making money on the suffering of these people.

There's also the issue of lack of education when it comes to letting these people know about alternatives, such as kratom. Hell, these people in need could have been growing their own poppy this whole time and could be sitting on pounds of pods, or large quantities of latex.


--------------------
Did you know the pen
Is stronger than the knife?
And they can kill you once
But they can't kill you twice
Did you know destruction of the flesh is not the ending to life
Fear not of the Anti-Christ

- Damian Marley -


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OfflineTheShroomanizer
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Registered: 06/12/09
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Re: [UK] Diamorphine shortage causing former heroin users to relapse for first time in a decade [Re: ElVatoFirme]
    #27828883 - 06/20/22 05:28 PM (5 days, 4 hours ago)

I think a big issues is that people are just different. And that every clinic, the entire medical community for that matter attempts to treat each case the same. Base line treatments are important, but can be counter productive, then again...catering every treatment to the individual is not cost effective, simply too many people. Also, people get dependency and addiction mixed up often...it’s my understanding that these maintenance clinics are not catering to the addictive properties, but to the physical and mental dependencies that were created from the addictive behavior prior to treatment. So...while inevitably there are some that don’t fit, I would say that addictive behavior can be treated...while simultaneously receiving therapeutic doses of 2A-Morphine to prevent withdrawal symptoms.

They did say that most of their participants are regularly tested for illicit drug use, which would work in their favor as it’s not drug seeking behavior, but symptom management.

Hope this helps


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InvisibleRotnpinsS
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Registered: 01/11/22
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Re: [UK] Diamorphine shortage causing former heroin users to relapse for first time in a decade [Re: TheShroomanizer]
    #27830194 - 06/21/22 01:05 PM (4 days, 8 hours ago)

Quote:

TheShroomanizer said:
I think a big issues is that people are just different. And that every clinic, the entire medical community for that matter attempts to treat each case the same. Base line treatments are important, but can be counter productive, then again...catering every treatment to the individual is not cost effective, simply too many people. Also, people get dependency and addiction mixed up often...it’s my understanding that these maintenance clinics are not catering to the addictive properties, but to the physical and mental dependencies that were created from the addictive behavior prior to treatment. So...while inevitably there are some that don’t fit, I would say that addictive behavior can be treated...while simultaneously receiving therapeutic doses of 2A-Morphine to prevent withdrawal symptoms.

They did say that most of their participants are regularly tested for illicit drug use, which would work in their favor as it’s not drug seeking behavior, but symptom management.

Hope this helps




Yeah, I went through methadone treatment in 2 different states (I moved while I was tapering my dose down).. the first state was definitely geared more toward the dependency, however the other state focused more on addiction treatment.. they required everyone to do 2x 45 minute one-on-one counseling sessions and 2 groups every month until they had 2 years of clean drug tests..

Unfortunately the clinics are state regulated, so each state has their own requirements and standards of care.

It was a complete culture shock at first, but it does help weed out the clients that are just going to "stay well" until they're able to go back out and get their drug of choice vs those that are actually there because they're trying to get clean.

Addiction recovery is definitely 2 fold, like you mentioned.. that's what a lot of people don't understand about methadone treatment.. it's  not meant to replace dependency on one substance with another. It's meant to help with the withdrawal symptoms and cravings while youre in counseling/treatment  for the addiction side


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Check out this very helpful write-up that every noob should read at least once- here

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OfflineTheShroomanizer
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Registered: 06/12/09
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Re: [UK] Diamorphine shortage causing former heroin users to relapse for first time in a decade [Re: Rotnpins] * 1
    #27830499 - 06/21/22 04:21 PM (4 days, 5 hours ago)

Exactly spot on.  I wish that when people were discussing addiction and drug dependency that they would talk about dependency as a “result” of addiction, like a side effect, or a symptom...rather than as part of the root issue.

When treating people (especially opioid/opiate) for abuse issues...not properly preventing dependence withdrawals can actually stimulate more aggressive addictive behaviors. So it’s so very very important to address both.


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