Diamorphine shortage

by Richard on February 19, 2007

I’ve just been listening to a piece on the radio about the shortage of diamorphine in British hospitals. It is used both to keep cancer patients pain-free and also in the treatment of heroin addicts. A shortage of the drug means that these two vital areas of medicine are in competition with one another.

Meanwhile, our troops are in Afghanistan destroying poppy fields. How can that make sense? Why don’t we just buy the stuff?

{ 12 comments… read them below or add one }

1

malc 02.19.07 at 10:14 pm

Just because you’re buying the poppies doesn’t mean that you’re getting all of them….. if you’re not getting all of them someone else is, and the chance of them being as altruistic as you aren’t that good.

The only way to make sure that the poppies don’t end up in the wrong hands is to destroy them. Unless you can think of a way of watching over all the poppies fields in Afganistan…..???

2

Richard 02.19.07 at 11:50 pm

But destroying the poppy fields isn’t likely ever to get all of them either. So we destroy some fields, making enemies of the peope of Afghanistan by destroying their living *and* force them to deal with the bad guys who are trying to get heroin onto our streets.

There’s a shortage of diamorphine throughout Europe, I understand. The farmers won’t sell to the baddies if they can get a better price from us.

I strongly suspect that the reason we aren’t buying up the poppy fields has more to do with American sensibilities (I believe that even as a painkiller under medical supervision, diamorphine is illegal in the US) than it has with what’s best for British patients.

3

Larry B 02.20.07 at 5:03 am

Richard,

Where do you get your information on the causes of the shortage? Some googling turned up the following information. It looks as if some of your own compatriots greed is driving this one. Other articles don’t cite raw material supply as a problem either. Whoever blamed America for this one obviously thinks America is to blame for just about everything regardless of the facts.

Causes of the shortage
The origins of the shortage, now in its eighth month, lie in the unresolved problems at the Chiron factory in Speke. This resulted in the removal from the market of the provider of 70% of the UK’s diamorphine; this shortfall was exacerbated by an unexpectedly low level of stocks held by the other licensed producer CP-Wockhardt.

Whilst the problems at Chiron were unexpected, the way in which the shortfall quickly transformed itself into a full blown catastrophe for many patients reveal a deep seated, wholly avoidable problem in the way in which the NHS procures its diamorphine. It highlights a prioritisation of corporate profits over public health.

The core of the problem is that the NHS is compelled to source its requirements of injectable heroin from a tightly controlled, highly profitable duopoly. A duopoly whose existence is directly incompatible with the provision of a vital drug. The NHS pays some £41.36 per gram for diamorphine, as opposed to the £6.30 (9.45 Euro) paid by the Dutch health service. A further factor that contributes to the inordinately high cost differential between UK and Dutch or Swiss diamorphine lies in the difference in production method used. The only licensed form in which diamorphine can be sold in the UK is the most expensive one namely, freeze-dried amps; in both Holland and Switzerland, however, diamorphine is provided as powder, which can be dissolved for injection as required. When we consider that there is currently a glut in the world market of licit diamorphine such that prices have fallen by 12% in the last year, the government’s failure to resolve the current crisis is particularly worthy of condemnation.

4

Richard 02.20.07 at 8:42 am

Thanks for that Larry. Of course, that’s not the only view of the reasons for the shortage.
The Royal College of Anaesthetists puts it this way: “Drug manufacturers do not have ‘an industrial chemistry set’ dedicated to the production of an individual drug, but rather they produce drugs in batches, according to projected demand, both of quantity, concentration and dose. The supply and storage of raw material is crucial, particularly when special conditions of temperature and atmosphere are required to prevent degradation. Outside patent restrictions, profit margins are small and for many drugs, it is just not worth a manufacturer’s while to produce a particular drug. Although the scandal of overpriced generics has recently hit the national press, this is concerned with high volume manufacture and not with the relatively limited market of some anaesthetic drugs. Frustratingly, it seems inevitable that the commercial issues behind drug manufacturing and supply, particularly for those outside patent and therefore where profit margins are limited and competitive, will continue to produce shortages from time to time.”
You’re right, though. Merely increasing the supply of the raw material won’t solve the shortage issue and it was simplistic of me to suggest it would. On the other hand, gathering what’s already been grown in Afghanistan couldn’t hurt. But how do you think your Administration would react were the British government to suggest it?

This is not about blaming the US for everything. But sometimes the interests of our two nations differ and I fail to see why US interests should always have priority. Apart, obviously, from the fact that you’re bigger than us.

5

malc 02.20.07 at 6:31 pm

It’s easier to see a field and destroy it than to see a field and know where the poppies will end up in the future……

6

rad 02.20.07 at 7:26 pm

I thought of posting a link to this very interesting article on the matter i had read couple of weeks ago. (Can’t provide a hyperlink, sorry)

http://www.economist.com/world/international/displaystory.cfm?story_id=E1_RQJJGVV

In addition, the same magazine’s November end issue ran this:

Heroin dominates Afghanistan’s economy

ONE grudging tribute sometimes paid the Taliban is that the brutal fundamentalists did at least curb Afghanistan’s enormous poppy crop. However, a report* published this week points to evidence that the Taliban’s nearly total ban on opium production in 2000-01 “carried the seeds of its own lack of sustainability”. The conclusion highlights just how difficult opium-eradication will be.

During the ban farmers found themselves deep in opium-related debt. This forced them to replant the crop as soon as it was safe to do so. In the meantime, the ban weakened the Taliban’s political standing. Certainly, opium production has soared since their overthrow, with this year’s showing a 49% increase over 2005, and providing 92% of world supply. As a result, the economy is hopelessly hooked on heroin.

“Opium GDP” [contribution of opium to growth of the country] is estimated at 27% of the total economy (ie, including drugs) and 36% of “licit GDP”. The report argues that, along with aid inflows, this is causing “Dutch disease” [in layman terms, high demand and hence high price of opium pushes the exchange-rate up, making other more important imports more expensive for the Afganians] , pushing up the exchange rate and other prices, making the non-opium economy uncompetitive.

So opium has a huge effect on the rest of the economy. A corollary is that eradicating it would have a devastating impact unless accompanied by decades of development. A simulation of an interdiction campaign starting now suggests that by 2010 real total GDP would have fallen by 10.7%, and “licit GDP” would not have grown at all.

link for this: http://www.economist.com/world/asia/displaystory.cfm?story_id=E1_RPGPDPP

I hope this enhances your perspectives

7

rad 02.20.07 at 7:29 pm

The report to which the second (in text) article refers to is:

* “Afghanistan’s Drug Industry: Structure, Functioning, Dynamics and Implications for Counter-Narcotics Policy”, The United Nations Office on Drugs and Crime and the World Bank

8

Chris 02.20.07 at 9:32 pm

Destroying Nature should be a criminal act. What gives any country the right to destroy the work of other people. It is about time that America and the UK too realise that other country’s ways of life and culture are as equally valid as our own. I can just imagine the outrage if someone from a quiet, non-industrialiseed country decided to destroy all of America and Britain’s earth destroying industries that threatens the survival of their environment, nature and people.

9

DH 02.20.07 at 10:21 pm

Well Chris. I would say in terms of environmental problems we need to point equally to third world nations where there is no EPA or European standard and where emissions are much worse per capita than the UK and US combined. Also, we need to look at rainforest problems that are caused more by the third world nations not following EPA and European standards. We need to point to China, India and the like where environmental standards are non-existent. It is easy to make blanket statments towards the US, UK and other Western nations without looking where ALL environmental problems originate and how that these problems truly won’t be solved until both Western nations (which have dramatically reduced emissions compared with the 1970’s) AND third world nations of China, India and the like follow the same. It seems the third world nations get a “free pass” on these issues because of economics when ALL should be following the standards. That is why I really see the so-called “solutions” are really so-called solutions to other non-mentioned so-called problems “economic equality” and “redistribution of wealth”. These should only be pursued voluntarily and on an individual basis not on a basis globally where more people are hurt by this redistribution. It is also very inefficient as compared to Western ecoomies. Many nations who haven’t had Western ecomomies who now have western ecomonies are becoming very successful: Czech, Poland, etc. We can see that we need to address the problem from a different way that from a “social justice”, “everyone makes the same” way. When one sees lower inflation and lower unemployment of western style economies it doesn’t make sense how nations don’t adapt and learn from the western economic landscape.

10

J 02.21.07 at 12:18 am

Don’t waste your breath (er, fingers) DH. Chris is defending a culture that made it a crime to teach girls how to read, and whose debate over gay rights was about what method of execution was appropriate. For Chris, the next time you want to criticize some Hummer drivng American, just remember that “other country’s ways of life and culture are as equally valid”.

“I can just imagine the outrage if someone from a quiet, non-industrialiseed country decided to destroy all of America and Britain’s earth destroying industries”

Personally, I wouldn’t miss all those organic farms (http://news.independent.co.uk/environment/article2283928.ece).

For Richard, I have to agree with the “buy the stuff” idea, though I suspect there are economic counterarguments. I’ve never seen a study on the subject, but I know the raw material suppliers aren’t the people really profiting from that drug trade, so it would be interesting to see if we could simply outbid the other side at a lower total cost than what we spend fighting illicit drugs now. I know we’ve tried paying farmers to grow something else, with little success, but that might be because we’ve failed to take all the costs we incur from illicit drug use into account and bid too low.

Personally, I’d take measures to eliminate demand, but most people I talk to are uncomfortable with what would need to be done to accomplish that.

11

Larry B 02.21.07 at 4:57 am

“But how do you think your Administration would react were the British government to suggest it?”

I’m guessing not particularly favorably, but who knows. America has had a pretty bad experience with opioids in the past, so I can understand the position. According to reports I’ve seen - don’t know for sure - one of the most devastating after effects of the civil war was the soldiers addictions to morphine. At the time, addiction wan’t as well understood as it is today, but that experience arguably left a scar on America that’s not going to be easily overcome.

Having learned from my wife - who is a certified expert in brain based learning - how drugs like opioids actually chemically alter the brain and create lasting physical changes in the brain makes me extremely leary of their broad usage even if it is for humane reasons. I’m hopeful one day they can find ways to target pain centers without having to do to the brain what the opiates are doing. In the meantime, it’s kind of an awful choice - excruciating pain or addiction.

12

chris 02.21.07 at 5:51 pm

i am certainly not defending any culture that does as you say. i am, however, attacking a culture that thinks because it has better weaponry, it can do what it likes to other countries and cultures.
As for your quip re organic farming, well - you may be happy yo eat food covered with chemical pesticides and to drink milk heavily dosed with antibiotics etc. but guess what - I am not. Anyway, just thought I would defend my original post.

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