Morphine Injections Supply Problems

MAIN POINTS:

  • Currently, there are national supply issues with Morphine Injections, predominately 10mg/ml amps but other strengths may be in short supply.
  • Practices should continue prescribing morphine injection first line in palliative care but if possible contact community pharmacies at the point of writing the prescription to ascertain stock levels so the prescription can be written for the available strength of amp and correct dose. Do not use morphine if the 10mg, 15mg, 20mg and 30mg ampoules are not available.
  • Prescribe short duration prescriptions of morphine (no more than 5/7 days) in order to ensure we can maintain supplies to all patients in need.
  • Prescribe Morphine Injection on a separate prescription from any other medication prescribed
  • Please ensure that all prescriptions and administration dosages are double checked by GP practices, Community Pharmacists and Community Nursing to reduce the risk of prescribing and administrative errors and that this is clearly communicated to patients and carers.

Current national supplies of 10mg/ml morphine are being prioritised for hospital use only.

Primary Care should continue prescribing morphine first line in palliative care but consider prescribing shorter durations (5/7days) to preserve stocks and prevent waste.

If prescribers contact community pharmacies at the point of writing the prescription to ascertain stock levels, this will ensure that the prescription is written for the available strength and correct dose, so preventing delay in treatment for palliative care patients. Different wholesalers are used by different community pharmacies and therefore different stocks of morphine may be available.

Clinicians are advised to take extra care if the ampoule strength is higher than normal (i.e. 15mg/ml or 30mg/ml). Do not use morphine if the 10mg, 15mg, 20mg and 30mg ampoules are not available as there is a high risk of the wrong dose being given with higher strength ampoules. Contact specialist palliative care for advice if you are unsure about converting to a different opioid.

If patients require low doses for example 2.5mg subcut then 10mg/ml amps must only be used.

If these are not available please contact the specialist palliative care team for advice.

Prescribing Morphine injection on a separate prescription form from any other medicines prescribed at the same time allows the patient to have their other medicines dispensed separately. The Morphine prescription can be taken away and dispensed in an alternative pharmacy.

The MO team will provide further updates as they become available.

(Adopted from ND/DDES CCG MO Team Memo – October 17)