There has been a warning that a shortage of the drug diamorphine, which is used as a clinical substitute for heroin, may be causing severe problems for patients in England. The BBC reports that diamorphine is prescribed to heroin addicts who don’t respond to methadone, and it is also used as a pain relief drug for end-of-life care.

Diamorphine hydrochloride is derived from morphine and is highly addictive, because it binds with opioid receptors in the central nervous system. It is illegal to use or sell in the UK, and most other countries, without a prescription, and its distribution and use is strictly regulated.

The drug works well for former heroin addicts who have not been successfully treated with other substitutes, such as methadone. Health care workers are concerned that the shortage will drive former addicts back to using illegal heroin again, in some cases after many years of staying away from illicit drug use.

Claire Robbins, nurse advocate and drugs adviser at the charity Release, told the BBC: “This is the worst shortage that I’ve ever been aware of. These are patients who have not used street heroin for decades in some cases and there is a real risk that someone is going to die in this current drought.”

She added: “We urgently need to secure a stable supply of diamorphine for these patients. The UK is currently experiencing the highest rate of drug-related deaths on record. This is a crisis.”

Other drugs have also been in short supply this year, owing to the backlogs and bottle necks that have built up in the global pharmaceutical supply chain over the past two years. The price of certain chemicals needed to produce drugs has also increased.

Accord Healthcare, who manufacture the drug, explained that the complex manufacturing process has been held up because of a problem with converting it into its final freeze-dried form, rather than because they cannot obtain the raw materials to make it. The company said that it was working hard to resolve the issue.

A spokeswoman for the Department of Health and Social Care said the government was aware of the ongoing issue with diamorphine injections. She added: “We want to reassure patients that alternative opioid products, including all forms of morphine, remain available and if they have any concerns, they should speak to their prescriber or pharmacist.”

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

The drug is not just used to treat former heroin addicts, but also for extreme pain, in cases of terminal illnesses or some types of surgery. Some hospital doctors have complained that the issue started back in May 2020, and there has been no improvement since. The problem is also affecting patients in Northern Ireland, while Scotland uses a different supplier.

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