Morphine oral liquid: Supply issue

Last Updated: 24 April 2024

Supply issue Active

There is a New Zealand wide shortage of morphine oral liquid.

On this page

Supply situation

As of 24 April 2024, there is stock of the Oramorph brand of morphine oral liquid. Pharmacists are encouraged to talk to their wholesalers about sourcing stock.

The Oramorph brand has received Medsafe approval (Gazette Notice(external link)).

Alternative brand

Oramorph is listed and available. It is slightly different from the previously funded RA-Morph brand.

Oramorph oral liquid morphine

Chemical: Morphine sulphate
Presentation: 10 mg per 5 ml (2 mg per ml) (100 ml)
Brand (Supplier): Oramorph (Clinect - supplied through Healthcare Logistics)
Description: Colourless to pale yellow
List date: 1 March 2024

Supply status

Stock is available.

Important differences from the RA-Morph brand:

Labelled 10 mg per 5 ml (equivalent to 2 mg per ml)
Different morphine salt (sulphate instead of hydrochloride)
Contains alcohol (ethanol) 10%v/v as a preservative

Morphine salt

We’ve received clinical advice that the salts are interchangeable and have no impact on the equivalent dose of morphine.

Alcohol content

The alcohol content in 5 ml of Oramorph is equivalent to 10 ml beer or 4 ml wine.

We are aware this could present issues for use for certain groups of people including children, pregnant or breastfeeding women, and people recovering from Alcohol Use Disorder or dependency.

We suggest anyone with concerns about this speak with their prescriber or pharmacist.

Finding alternatives is challenging

Pharmac has been looking for alternative brands of morphine oral liquid for at least 18 months. Unfortunately, finding both short and long-term supply has been challenging.

The logistics of making and supplying controlled drugs, like morphine oral liquid, is complex.

Special licences are required to import and export controlled drugs. Pharmac is working closely with suppliers on permits and labelling to speed up the delivery of stock to Aotearoa New Zealand.

People using morphine oral liquid

Expect different brands

If you have previously used morphine oral liquid, you will get different brands than you are used to. Please talk to pharmacist about what these changes mean for you.

You may also need a new prescription.

Healthify have developed some guidance for people who take morphine oral liquid.

Wockhardt and Oramorph oral liquid morphine - patient flyer - March 2024 [PDF, 181 KB]

We apologise

We know that supply issues can be disruptive and we apologise for any problems that this issue might cause.

We continue to work to reduce the effect of this supply issue on people who use morphine oral liquid.

Prescriber information

Due to the limited availability of morphine oral liquid, we ask that you:

use clinical discretion to preserve morphine oral liquid for people who need it the most.
consider using other presentations of morphine, such as Sevredol immediate release tablets, where possible.
avoid moving patients to oxycodone oral liquid or immediate release capsules, if possible. Supply of these products is constrained.

Clinicians will need to decide on an appropriate treatment course for their patients.

Schedule listing for Sevredol(external link)

The different morphine salts are interchangeable

Clinical advice states that the different salts of morphine (sulphate compared to hydrochloride) are interchangeable and have no impact on the equivalent dose of morphine. RA-Morph contains the morphine hydrochloride salt and Wockhardt and Oramorph contain the morphine sulphate salt.

Alcohol in Oramorph

Oramorph contains alcohol (ethanol) 10% v/v as a preservative. The alcohol content in 5 ml of Oramorph is equivalent to 10 ml beer or 4 ml wine. The datasheet for Oramorph outlines that this is not likely to have an effect in adults and adolescents, and its effects in children are not likely to be noticeable. However please counsel affected individuals about this.

Morphine oral liquid supply on Practitioner’s Supply Orders (PSO)

Morphine oral liquid is available on Practitioner’s Supply Order (PSO). Normally unregistered medicines cannot be used on PSO because section 29 of the Medicines Act requires that the patient to be known at the time of supply.

As holding an emergency supply of oral morphine may be essential for patient safety, s29 morphine oral liquid can be supplied to medical practitioners on a PSO. The practitioner must provide the patient details to the pharmacy retrospectively.

Health care professional resources

Pharmacist information

Strength changes

Please counsel affected people and their whānau and caregivers on the strength of morphine oral liquid that they are receiving and the dose they need to use.

Please take extra care with the different labelling of the strength of the alternate brands. Strengths of the Oramorph brand is labelled as per 5 ml, whereas RA-Morph is labelled as per 1 ml.

Healthify has developed this flyer to support your discussions with patients.

Wockhardt and Oramorph oral liquid morphine - patient flyer - March 2024 [PDF, 181 KB]

Caution stickers

Caution alert stickers are available to order for free from PharmacOnline (under the miscellaneous category). You may need to refresh the web page.

Order stickers from PharmacOnline(external link) (Use the "Public User" button)

Brand switch fee

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.

To support this a brand switch fee will be claimable from 1 December 2023 to 1 June 2024. The brand switch fee has been applied on the morphine sulphate oral liquid 2 mg per ml presentation. This means you can only claim one brand switch fee for both the Wockhardt and Oramorph brands.

More about brand switch fees

Resupply

We are working closely with a supplier, LumaCina, to re-introduce the RA-Morph brand. LumaCina has taken over the Australian manufacturing plant where RA-Morph was made.

LumaCina, Medsafe, and Pharmac have been working together to get RA-Morph back in Aotearoa New Zealand later this year.

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.

Background to the supply issue

In July 2021 Pharmac included morphine oral liquid in the 2021/22 Tender. No bids were received.

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

In November 2022 Pharmac was notified of the sale of this manufacturing plant to LumaCina.

In March 2023, Pharmac ran a Request for Proposals for the supply of pharmaceutical products affected by the plant closure, including morphine oral liquid. Morphine oral liquid received no bids. Pharmac staff continued to source alternatives.

In September 2023 we were notified that the previous supplier had sold the right to make and sell RA-Morph to LumaCina. LumaCina confirmed that it can resume manufacturing of RA-Morph for the New Zealand market.

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

End of March 2024. All remaining RA-Morph stock expires.