The aftershocks of Covid-19’s stranglehold on the global supply chain are affecting the availability of some essential medicines in South Africa. Medical associations and pharmaceutical organisations are concerned about the low supply of morphine powder and 150 other medicines across the country.

CEO of the Independent Community Pharmacy Association (ICPA),  Jackie Maimin, said medicines used to treat everything from anxiety to menopausal symptoms to inoperable breast cancer are in low supply.  

Among these drugs are:  

• Morphine powder and ampoules used in palliative care for cancer and terminally ill patients
• Irbesartan treats high blood pressure, heart failure and diabetic kidney disease
• Provera tablets to treat abnormal uterine bleeding and restore the normal menstrual cycle
• Depo-Testosterone for impotence delayed puberty in males and inoperable breast cancer in women
• Denetrin and Halcion  for anxiety
• Zithromax Paediatric Suspension, which is an antibiotic

“80% of our raw materials come from China and India. Any slowdown in their production has a knock-on effect on us. We managed these shortages throughout the pandemic and continue monitoring them. It will take some time for production to catch up and distribution to normalise,” said Maimin.

However, Maimin said many countries are affected, so shortages in SA were expected. She said some healthcare facilities are more affected by others depending on their stock holding. 

Pharmacies under pressure to source alternative medicines

“This may be a generic substitution (the same product made by a different manufacturer), or if a particular medicine is out of stock across all suppliers, then we contact the prescriber and get a therapeutic substitution which is a different medicine which does the same job, e.g. lowers blood pressure”, she said. 

Maimin said generic substitute medication rarely causes adverse events in patients. However, some generics, like antiepileptics, blood thinners and certain heart medicines, need close monitoring.

“Therapeutic alternatives are more of a challenge and only considered when there is no other choice. The patient must be monitored and stabilised on the new medicine. Adverse effects are possible”, she said.

Essential medicine shortage impacts palliative care

ICPA said the shortage of end-of-life drugs to manage is concerning. For instance, morphine powder alternatives are expensive, burdening the patient and their families. However, even these alternatives are in short supply. Morphine powder is crucial during palliative care for cancer and terminally ill patients.

 “Ampoules and tablets are alternatives. But now the amps are out of stock, and tablets are not also viable as many very ill patients cannot swallow tablets. Pain relieving patches are another alternative, but these are very expensive, so there is a barrier to access for many,” said Maiman.

However, some palliative patients need a drug called Haloperidol which has no suitable alternative. 

Dr Margie Venter from The Association of Palliative Care Practitioners of South Africa (Palprac) said Haloperidol is often used at the end of life to manage patients with nausea and vomiting, confusion, and restlessness. 

“This drug is on the WHO essential medicines list and is available in many other African countries but is no longer available here. For the past two months, we have not had access to oral morphine – this is an absolute crisis as this is the only opioid available to patients with cancer pain in the state sector”, said Venter. 

Venter says that palliative care is about the quality of life for those with life-limiting illnesses. An essential part of that is symptom control, which often requires medication.

“With something like morphine, patients will suffer. Sometimes one can swap to an alternative medication, but that would have to be done in consultation with a medical doctor. Sometimes there is no other alternative”,  she said. –  Health-e News