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Australia is grappling with significant shortages of essential medications, including opioids, posing severe consequences to the people and families we care for as palliative care specialists — and it has been like this for over two years.
Key health organisations, including Palliative Care Australia (PCA), have been raising the alarm, but progress is slow. We currently have a critical shortage of medicines such as morphine and midazolam. People with palliative care needs are experiencing unrelieved and distressing pain and other symptoms while we wait for action.
The shortages and disruptions stem from a combination of factors. Globally there has been an important reckoning around the significant harm caused by the misuse of opioids.
Use of opioids internationally has shrunk, which has significantly altered the business model in this therapeutic area of the pharmaceutical industry. For Australia, a relatively small market at the end of the supply chain, it’s now obvious that relying on global demand and key industry players to ensure ongoing availability of previously accessible medicines for evidence-based use is flawed.
The scope of the crisis
A low point in this saga came in early 2023, when British pharmaceutical company Mundipharma (the sole supplier) announced the withdrawal of oral liquid morphine (Ordine) from the Australian market. Oral liquid morphine is on the World Health Organization model list of essential medicines (2023) for pain and palliative care. Subsequent notifications in late October 2023 indicated the planned discontinuation of an additional nine products containing morphine or oxycodone over the following 18 months. These include OxyNorm capsules, MS Mono capsules, and Sevredol tablets. As of April 2025, the list of medicines we are concerned about was well over 900.
These discontinuations and shortages threaten the safe delivery of evidence-based pain and symptom management — especially for vulnerable patients like young children and those with a cancer diagnosis. Not to mention the tremendous anxiety these announcements continue to cause.
To their credit, the Therapeutic Goods Administration has responded constructively and sought alternative medications. While the alternatives have provided a solution for some people; new twists to the dilemma facing clinicians, patients, and carers have emerged.
Even the supply of the alternatives has been variable, making it difficult to predict which alternative to prescribe, and for those without Pharmaceutical Benefits Scheme (PBS) subsidy, there is the issue of cost.
The mechanisms for PBS consideration mean patients and health systems can end up paying extraordinary prices.
A bottle of a previously available hydromorphone sustained-release medication cost the public $182 for 32 mg. The overseas alternative, which is not PBS-listed, is $4209 for 100 tablets — 23 times more expensive!
The final twist for a community and system under pressure is that there is not a clear mechanism to mobilise sufficient imports and then provide distribution across the country — particularly to community pharmacies.
To access pain relief medications, people who are dying may end up having to be admitted to hospital, which denies them choice and the ability to be cared for at home, where 90% of Australians say they want to be cared for.
Domestic production is part of the solution
To address the ongoing crisis and inspire the thinking of government, PCA, in collaboration with our partners — the Australia and New Zealand Society of Palliative Medicine, Advanced Pharmacy Australia, the Pharmaceutical Society of Australia, Palliative Care Nurses Australia, Pain Australia, and Ageing Australia — developed an 11-point plan aimed at resolving palliative care medicine shortages.
This comprehensive strategy includes measures to enhance domestic production, develop national stockpiles, streamline regulatory processes, and ensure a stable supply chain for essential medications.
The plan is a central pillar of PCA’s 2025 Federal Election Platform, which seeks better access to palliative care for all Australians.
The idea of these medications being made in Australia and freeing us of the international shackles central to the issue is one part of the plan getting a lot of attention.
Given that Tasmania is the world’s largest producer of the raw materials for pharmaceutical opioids, there is a compelling case for Australia to leverage our natural advantage and produce these critical pain relief medicines locally.
Acknowledging the constraints and regulations that would need to be navigated, Poppy Growers Tasmania have expressed willingness to expand the industry to support domestic production.
We made vaccines locally during the pandemic, and the federal government has just invested $20 million in the domestic production of intravenous fluids. We suggest going further with a sovereign supply of critical pain relief medications.
Government engagement and leveraging the election
Since coming to office three years ago, various health organisations and leaders have formally communicated their concerns to Health Minister Mark Butler, highlighting the urgency of the situation and the compounding sense of trauma and distress sitting with patients, loved ones and clinicians.
We appreciate that this issue is one of many major challenges the Minister has before him, but we are yet to see substantive action. In the meantime, people are dying in pain.
PCA will take part constructively in the taskforce that has been established to tackle the issue, clear in our view that we need to see action in the short and long term.
Our 11-point plan is a strong starting point and has received wide support. It offers actions that can be implemented during the first sitting of the 48th Parliament.
In the lead up to election day, over 40 000 people have signed our Better access to palliative care petition, calling for action on this issue, and we stand ready to work with the next government to respond to that need.
Dr Peter Allcroft, Senior Staff Specialist, Southern Adelaide Palliative Services and Clinical Lead, State Palliative Care Network, Palliative Care Australia Board Chair.
Professor Meera Agar, Professor of Palliative Medicine, IMPACCT Director, University of Technology Sydney, palliative medicine physician, South West Sydney Local Health District, and Palliative Care Australia Deputy Board Chair.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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A frustrating problem, given this situation, is that a significant amount of these medications are destroyed as the are dispensed to community patients and then not used. Perhaps a process could be developed where the medications are kept centrally by a Palliative Care Group and just taken to the patient’s home as required. Then if not used, they could be used for another patient.
In South Australia we had a company called Faulding which manufactured a large range of medical, dental and veterinary drugs and products. The company was well known and respected, and I kind of grew up with it as a medical student and young doctor. Then , somewhere around the 1980s it was bought out and taken over by a large American pharmaceutical company, which initially promised to continue manufacturing in Australia, but soon left and took it overseas ( no doubt the original plan.) This is one example of how Australia lost control of manufacturing and became totally reliant on overseas supplies, starkly illustrated during the COVID pandemic. As far as i can determine, nothing much is being done to correct this situation.
Thank you for raising this important issue and for summarising the situation so succinctly.
It is sometimes very difficult to find GPs who are willing to prescribe opioids for our palliative patients in the first place, and the additional barrier of medications not being available makes it even harder. It is extremely time consuming for palliative care services and GPs to try and source appropriate medications, and consider alternatives when the indicated medication is not available.
Our patients suffer as a result of the delay and the uncertainty in knowing if they will get access to symptom relief.