Shortage of morphine and controlled drugs in JDWNRH

Morphine drugs used mainly to relieve pain for cancer and terminal patients

A shortage of controlled drugs including morphine, which is used on cancer patients to relieve pain, has raised concerns among the health officials at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). The controlled drugs are Morphine, Pethidine, Fentanyl, Codeine and Tramadol.

The stock for morphine will last for another week or two. The shortage has happened as the two local suppliers of the drugs were disqualified and their licenses cancelled by the Drug Regulatory Authority in July this year. Consequently, the health ministry has cancelled all the supplies from local suppliers.

However, the procurement section and the administration was informed about the issue in advance and Department of Medicine Supplies and Health Infrastructure (DMSHI) was informed accordingly with the request to expedite the supply.

Suggestions were also provided to source the items directly from the manufacturer. It was learnt that the local suppliers, KMT and Paras, were supposed to supply the morphine tablets but were disqualified due to the cancellation of their certificates by Drug Regulatory Authority. Following this the health ministry has cancelled all the supplies from the local suppliers.

Medical Superintendent, Dr Gosar Pemba, said there is an increase in the usage of morphine for cancer patients. In December 2018, JDWNRH has received 40,000 morphine tablets but still it is not enough.

He said since JDWNRH has started radiotherapy and chemotherapy, most of the cancer patients that travel to India are kept here. So that has also led to increased use of morphine.

Another reason is because the supply was discontinued, he added.

“We are expecting 50,000 morphine tablets with an additional increase of 20 percent extra tablets this year until next supply. So every year, there is an increase,” said Dr Gosar Pemba.

“Other supply has started coming except for the controlled drugs, and we are worried that by the end of September or mid of October, the controlled drugs should reach the hospital or else there will be problem if it is late. DMSHI has just started re-tendering for the supply of controlled drugs, this might take time,” said Dr Gosar.

“Right now, we do have stock which will last a week or two,” said Dr Gosar.

He said, in the palliative care, the usage of morphine is high since it is the end of life where there is no hope for recovery and to is used make the patients’ lives more comfortable without any pain.

He also said that the supply of controlled drugs takes time and if the supply is late then there might be a crisis. So the discussions were held to request DMSHI to expedite the supply to avoid the situation later.

“Since almost all our controlled drugs are purchased by DMSHI, we are worried if the supply is late and also the controlled drugs cannot be bought anytime or anywhere and it is only bought in bulk once in the year,” said an official of JDWNRH.

For controlled drugs, it takes three months. We are expecting to receive them by October this year. But if the drugs do not arrive by October, there will be major crisis, said a health official.

In 2014, there was a similar incident and it was resolved after they sourced the drugs directly from the manufacturers. “So we have suggested the same to DMSHI in the last meeting,” the official said.

An official with DMSHI said they have already re-tendered the supply for controlled drugs and they are expected to reach by the end of September or by the first week of October.

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