NHS trusts forced to use ‘expensive’ pre-filled diamorphine syringes to manage ongoing supply issues

Demand has increased for “expensive” pre-filled syringes of diamorphine hydrochloride, as 5mg and 10mg ampoule products continue to face supply issues, hospital pharmacists have said.

Diamorphine hydrochloride, an opioid used to manage severe pain, first faced supply problems in February 2020, when the Department of Health and Social Care (DHSC) announced that the two manufacturers of 5mg and 10mg strengths — Accord and Wockhardt — were out of stock.

At the time, the supply disruption alert said that both manufacturers were expected to have stock by “summer 2020”.

However, Accord has since told The Pharmaceutical Journal on 5 July 2021 that it discontinued production of diamorphine 5mg and 10mg in 2020, owing to “exhausted supply”.  

Alison Tennant, chief pharmacist at Birmingham Women’s and Children’s NHS Foundation Trust, said her trust has been “managing stock tightly since March 2021”.

“We started ordering 10mg in mid-April [2021] and moved to 30mg at the end of April,” she said. “The 30mg are now out of stock until the end of August [2021].”

“We are sourcing pre-filled syringes [from Royal Liverpool University Hospital and Wirral University Teaching Hospital NHS Foundation Trust] that make the diamorphine go further … but of course these are expensive,” she said, adding that the aseptic facility in Liverpool has “had to ramp up their production significantly”.

“A lot of people have switched to the pre-filled syringes and the manufacturing units were saying that demand had ramped up significantly, such that they were having to put in extra resources to meet the demand,” Tennant continued.

Shakeel Herwitker, head of manufacturing services at the Royal Liverpool University Hospital pharmacy department, confirmed that “demand for syringes has increased”.

Tennant also said that using pre-filled syringes has created storage issues.

“They require refrigeration for 30 days but they’re a controlled drug, so they need to be stored in a fridge which is bolted to the wall, has a padlock on it and is in a restricted access area,” she explained.

But, Tennant added, there is “a shortage on drug fridges in the NHS at the moment,” with a lead time of “about four weeks”.

As a result, Tennant said the trust has “scooped up all the fridges that we were putting the COVID-19 vaccine in and put them into theatres”, securing them to the wall with a padlock.

In a statement to The Pharmaceutical Journal, Wockhardt said it “is honouring the 5mg and 10mg diamorphine product restocking dates of June and July [2021] to reduce the current supply shortage,” with future supplies to “be managed as planned”.

Peter Kelly, managing director at Accord, said: “The production of diamorphine is a complex process and at Accord we put quality at the core of our operations.

“We have been working closely with the Medicines and Healthcare products Regulatory Agency, the DHSC and across our supply chain to rectify the situation.

“Whilst we had informed the DHSC [in 2020] that we had discontinued the 5mg, 10mg and 30mg strengths due to exhausted supply; we are fully in stock with both the 100mg and 500mg strengths and have a healthy supply in the forecast for the foreseeable future.”