Health groups demand urgent action on critical palliative care medicine shortages

An alliance of seven health organisations* has unveiled an 11-point plan to combat ongoing shortages of essential pain relief medicines, spotlighting the urgent need for reform in palliative care. The release of this plan comes against a stark backdrop: approximately 400 Australians die daily from terminal illnesses, yet more than 62% never receive specialist palliative care at any stage.

Frustration over the prolonged shortages has reached a tipping point, with the groups, including Palliative Care Australia, Pharmaceutical Society of Australia and Pain Australia, penning an open letter to Members of Parliament with medical backgrounds. The letter paints a devastating picture of end-of-life care, marked by pain, distress, and insufficient access to vital medicines.

The organisations are calling for immediate action, including the removal of PBS patient contributions for medicines under the Palliative Care Schedule – effectively making these medicines free for patients and their families.

Despite repeated appeals to the Minister for Health, the Therapeutic Goods Administration (TGA), and the Department of Health and Aged Care, progress on ensuring a stable supply of these essential medicines remains elusive.

The letter, co-signed by some of Australia’s most respected clinicians, underscores the gravity of the situation; “Many of the affected medicines are vital opioid analgesics that have been used for decades to manage severe pain and other symptoms in palliative care patients. With the supply of these medicines becoming increasingly uncertain, clinicians are forced to prescribe less effective alternatives, resulting in less reliable pain relief and risking unwanted side effects,” it states.

The ripple effects extend far beyond clinical care. “Families, already grappling with the emotional toll of a loved one’s decline, are often left navigating these disruptions, with the added stress of figuring out alternatives, often at substantial financial cost where alternatives are not available on the PBS,” the letter continues.

Palliative Care Australia Chair, and practising palliative care physician in south west Sydney, Professor Meera Agar said having to swap between various products to fill the gap in the supply chain is an unnecessary workaround with significant impacts for people where time is precious.

“Pain management requires an individualised approach. It’s work we do side by side with the patient and their carer, who is often the person administering this medication,” Professor Agar said. “It’s easy to get confused about how to manage your medications when it keeps being swapped around depending on supply, not to mention the side-effects that can come from new and changing medicines.”

The real-world consequences are profoundly felt by patients and carers alike. “It is so sad that this hasn’t been addressed and managed properly. As someone with an elderly mother needing regular Ordine, the stress of accessing it has exacerbated our stress,” one carer told Palliative Care Australia. Another added, “Having to change to different medications at this stage of people’s lives is very challenging for them as the alternatives are often not as effective.”

In June 2023, Mundipharma advised that they were discontinuing supply of all Ordine (morphine) oral liquid medicines in Australia. In January 2024, Arrotex Pharmaceuticals took over ownership of these products. According to the TGA, a return to normal supply of all strengths by late January 2025 in anticipated.

“The cost of fully subsidising medicines on the PBS Palliative Care Schedule, medicines which have typically been used clinically for decades, is very low compared with the billions of dollars the Government spends each year on subsidising the cost of newly introduced medicines,” the letter said.

Data underscores this point: in 2022-23, 1.3 million scripts were filled under the Palliative Care Schedule, with 93% provided on a concessional basis. The estimated cost to the government would be $14.8 million annually.

As the 2025 Federal Election approaches, Palliative Care Australia is amplifying its campaign under the banner of four key pillars, with “Better access to critical palliative care medicines” taking centre stage.

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Organisations:

1. Palliative Care Australia
2. Australia New Zealand Society of Palliative Medicine
3. Advanced Pharmacy Australia
4. Pharmaceutical Society of Australia
5. Palliative Care Nurses Australia
6. Pain Australia
7. Aged and Community Care Providers Association