Morphine oral liquid: Supply issue

Supply issue Active

There are some supply disruptions affecting some presentations of morphine oral liquid (RA-MORPH).

On this page

16 February 2024 Update

Remaining stock of the RA-Morph 2 mg / ml is currently being supplied to the market. Once this has run out, the Wockhardt 2 mg/ml morphine oral liquid will be supplied. If pharmacies or wholesalers have any of RA Morph 2mg per ml, they should use this first (it expires on 31 March). 

Pharmac is arranging another brand of the 2 mg / ml presentation to help cover supply. We anticipate that this brand will be listed on the Schedule from 1 March and reach the market in late March 2024. 

Supply situation

There is a supply issue with the funded brand of morphine oral liquid (branded as RA-Morph). We’re working as hard as we can to source alternative products to reduce the impact on people who use morphine oral liquid and the healthcare practitioners, whānau and carers supporting them.

We expect the supply of all strengths of the current funded brand of morphine oral liquid (branded as RA-Morph) to be resupplied by mid 2024. 

We’re continuing to explore other options to ensure we have morphine oral liquid available for the New Zealand market.

Affected products

The current funded presentations of morphine oral liquid are:

  • Chemical: Morphine hydrochloride
  • Presentations: 1, 2, 5 and 10 mg per ml (200 ml)
  • Brand (Supplier): RA-Morph (Juno)
  • Description: colourless to pale yellow

MORPHINE ORAL LIQUID PRESENTATION

STOCK UPDATE

RA-Morph 1 mg per ml (Pharmacode 754285)

Out of stock.

RA-Morph 2 mg per ml (Pharmacode 754293)

Stock expires 31 March 2024.

RA-Morph 5 mg per ml (Pharmacode 754307)

Stock expires end of March 2024

RA-Morph 10 mg per ml (Pharmacode 754315)

Out of stock.

We estimate stock levels based on the current demand for each strength. That means our stock updates may change in the future if demand for each strength changes.

Schedule listing for morphine oral liquid(external link)

Alternative brands

We have arranged temporarily supply of a 10 mg per 5 ml product (branded as Wockhardt). This product is equivalent to 2 mg per ml and is supplied by CDC Pharmaceuticals. 

The temporary brand of morphine oral liquid is:

  • Chemical: Morphine sulphate
  • Presentation: 10 mg per 5 ml (2 mg per ml) (100 ml)
  • Brand (Supplier): Wockhardt (CDC Pharmaceuticals)
  • Description: Colourless to pale yellow

The Wockhardt brand is a different morphine salt (sulphate instead of hydrochloride). We’ve received clinical advice that these are interchangeable and have no impact on the equivalent dose of morphine.

We are continuing to source other alternative supplies of morphine oral liquid.

The logistics of making and supplying controlled drugs, like morphine oral liquid, is complex. We’re working closely with suppliers on the export and import permits and labelling which is required to expedite the delivery of stock to New Zealand

Wockhardt brand morphine oral liquid must be supplied under Section 29

The Wockhardt brand of morphine oral liquid is not approved by Medsafe. This means it needs to be supplied in line with Section 29 of the Medicines Act 1981.

While not approved for use in New Zealand, Wockhardt morphine oral liquid 10 mg per 5 ml (equivalent to 2 mg per ml) is approved and used in the UK.

We know listing an unapproved medicine is not ideal and will result in prescribing being restricted to medical practitioners where the person taking the medicine is known. In this case however, we consider this is a better option than not having morphine oral liquid available.

Advice for prescribing under Section 29 – BPAC website(external link)

Prescriber and pharmacist requirements for Section 29 medicines – Medsafe website(external link)

Medsafe’s Section 29 Declaration / Notification Form [DOC](external link)

What people need to know about unapproved medicines – Healthify website(external link)

Information for people using morphine oral liquid

If you have a repeat prescription for morphine oral liquid 1 mg per ml and this strength is not available, you will need to get a new prescription for an alternative strength. Please talk to your pharmacist about this if you are not sure.

To support people using morphine oral liquid who may need to change strengths, Healthify has created an informational resource. This mentions the Wockhardt brand but is relevant to any 2 mg per ml strength.

Information for pharmacies

Pharmacists will need to ensure people affected by this change are supported to understand the strength of morphine oral liquid that they are receiving. They need to be aware of what volume they need to take to receive the appropriate dose.

You can download and print the information sheet linked above, to help your discussion with individuals or their whānau or carers. 

When alternative brands are available, please take extra care with the different labelling of the strength. The Wockhardt brand is labelled as per 5 ml, whereas the other presentations are labelled as per 1 ml.

Repeats for morphine oral liquid 1 mg per ml cannot be substituted with morphine oral liquid 10 mg per 5 ml (equivalent to 2 mg per ml). This means people who have a repeat waiting to be dispensed for RA-Morph, 1 mg per ml will need a new prescription from their doctor.

Brand switch fee

We know that counselling people about a change like this takes extra time. To support this a brand switch fee will be claimable from 1 December 2023 to 1 June 2024.

This is the first brand change for morphine oral liquid and involves a change in strength and salt. We know some people using morphine oral liquid will need additional support from their pharmacist with this change and may have questions.

More about brand switch fees(external link)

Health care professional resource

He Ako Hiringa have published guidance for prescribers and pharmacists on this issue. 

Morphine oral liquid - He Ako Hiringa(external link)

Background to the supply issue

In September 2021 the then supplier of RA Morph advised that they were closing their Perth factory which made morphine oral liquid.

In April 2023, the previous supplier of the funded brand of morphine oral liquid (branded as RA-Morph) notified Pharmac of the sale of its Perth factory.

In August 2023 the previous supplier advised it had sold the right to market and sell RA-Morph to Lumacina. Lumacina has confirmed that it intends to re-start making RA-Morph for the New Zealand market

In September 2023 remaining stock of RA-Morph was transferred to Lumacina New Zealand’s distributor, Juno, and is currently being supplied to the market. 

Who to contact

If you have questions about morphine oral liquid, please email enquiry@pharmac.govt.nz

Please include as much information as you can about the product (presentation, brand, pharmacode) and who your wholesaler is.  

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