The supply picture for diamorphine injection (ampoules) for the national health service in England for the years 2002 to 2006 is shown in the following table.
Units in thousands 2002 2003 2004 2005 2006 l0 mg (total) 1,218 1,271 1,275 552 682 l00 mg (total) 410 440 451 169 141 30 mg (total) 839 872 908 408 557 5 mg (total) 1,366 1,448 1,444 496 218 500 mg (total) 30 37 29 20 22
In March 2007 the NHS Purchasing and Supply Agency (NHS PASA) estimated the following availabilities, against historic demand, by strength:
Percentage 5 mg 26 10 mg 84 30 mg 100 100 mg 31 500 mg 100
A combination of the analyses highlights that there has been a significant recovery in the supply of 10 mg and 30 mg strengths against historic demand.
However, prescribing of these two strengths has not returned to original levels and there has been an excess in the supply of these strengths against current demand as a result.
In the case of the 5 mg and l00 mg strengths the supply position has not recovered. There is an ongoing shortage of these strengths and it is not possible to estimate true current demand as a result.
When the shortage of diamorphine first arose in December 2004, the remaining supplier immediately increased its production, and the Department took steps to ensure that adequate supplies of alternative painkillers were available. In addition, the Department issued an alert to the national health service via the chief medical officers cascade system, warning health care professionals about the shortage and advising them to avoid wastage, and to consider alternative painkillers wherever possible and reserve diamorphine supplies for those patients whose need was greatest. Both suppliers are now fully in production. The supply situation improved during 2007, and is expected to continue doing so during 2008.