Opioid Agonist Treatment Alert: Potential Slow Release Oral Morphine Shortage

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Opioid Agonist Treatment Alert: Potential Slow Release Oral Morphine Shortage

From The British Columbia Centre on Substance Use

 

Update: The Shortage of slow-release oral morphine, brand name KADIAN® , for the treatment of opioid use disorder has been resolved. 
Kadian®  Shortage Information - January 2018 (February 7, 2018)

Pharmacists may be encountering a shortage of Kadian®, used for pain indications and opioid agonist treatment (OAT). The shortage is primarily of higher-dose capsules: 20 mg, 50 mg, and 100 mg. 

Recent communication from the BCCSU advised that M-ESLON® could be used instead of Kadian®. As a reminder, M-ESLON® is not a benefit under PharmaCare Plan G, and there is no PIN for M-ESLON® for OAT, so please use all means at your disposal to obtain Kadian® for your OAT patients. Do not dispense M‑ESLON® under the Kadian® PINs. If you receive a prescription for M-ESLON from a patient covered only by Plan G, please contact the prescriber to arrange for Special Authority for coverage.

If you receive a prescription for Kadian® and do not have appropriate strength Kadian® capsules in stock, please contact nearby pharmacies to obtain stock and ensure procedures for emergency narcotics stock transfer are followed. For assistance locating pharmacies with Kadian® stock, please contact the BCCSU during regular office hours (Monday through Friday, 8:30 a.m. to 5:30 p.m.) at 604-416-1535. 

For more information about the Kadian® shortage visit the PharmaCare site.
Update from PharmaCare on the shortage of Kadian® (January 15, 2018)

The shortage of Kadian® is primarily for higher-dose capsules: 20 mg, 50 mg, and 100 mg. The 100 mg capsules are back-ordered until mid-February, but 20mg and 50mg capsules will be available as of Monday, January 15.

As a reminder, M-ESLON® is not a benefit under PharmaCare Plan G, and there is no PIN for M-ESLON® for OAT, so please use all means at your disposal to obtain Kadian® for your OAT patients. Do not dispense M-ESLON® under the Kadian® PINs.

If you receive a prescription for Kadian® and do not have appropriate strength Kadian® capsules in stock, please contact nearby pharmacies to obtain stock and ensure procedures for emergency narcotics stock transfer are followed.

If you have Kadian® stock on hand and do not regularly dispense to your patients, or if you have more stock than you need in the short term, please contact the BCCSU during regular office hours (Monday through Friday, 8:30 a.m. to 5:30 p.m.) at 604-416-1535, so they can assist in ensuring there are no treatment gaps for OAT patients. 

The Ministry of Health is working with the manufacturer and distributor to resolve the shortage as quickly as possible.

There is potential shortage of some dosage strengths of slow-release oral morphine (SROM) brand name KADIAN® for the treatment of opioid use disorder. More information can be accessed via the website https://www.drugshortagescanada.ca; search records for “Kadian”.

There may be a backlog of orders yet to deliver at select pharmacies so your patients may be reporting that their pharmacies cannot fill their prescriptions.

This includes some dosage strengths and the corresponding DIN PINs:

NAME PIN DIN
Kadian® 10 mg capsule 22123349 2242163
Kadian® 20 mg capsule 22123346 2184435
Kadian® 50 mg capsule 22123347 2184443
Kadian® 100 mg capsule 22123348 2184451

Clinical management for all patients currently on KADIAN® for opioid use disorder:

  • Contact patient, discuss options below, determine treatment plan and document in patient’s medical record
  • Cancel existing SROM prescription

IMPORTANT NOTICE: The options below are temporary measures to address potential shortages of KADIAN®. Patients should be transitioned back to once-daily dispensed KADIAN® as soon as possible when the shortage is over.

 

OPTION 1 – Convert Patients to M-ESLON®

  • Convert and write a prescription for 12-hour sustained-release oral morphine brand name M-ESLON® (same therapeutic dosage of KADIAN®, but divided into 2 doses)
    • e.g., KADIAN® 400 mg/day is equivalent to M-ESLON® 200 mg BID
  • This will include one DAILY WITNESSED AND DISPENSED dose of M-ESLON® and one AFTERNOON CARRY (or second witnessed dose as per prescriber)
  • See table below for information on available M-ESLON® dosage strengths and DINs:
NAME DIN
M-Eslon® 10 mg capsule 02019930
M-Eslon® 15 mg capsule 02177749
M-Eslon® 30 mg capsule 02019949
M-Eslon® 60 mg capsule 02019957
M-Eslon® 100 mg capsule 02019965
M-Eslon® 200 mg capsule 02177757
  • Convert patients back to once-daily dispensed KADIAN® when the shortage is over
  • NOTE: M-ESLON® is eligible for coverage under PharmaCare Plan C, but not under PharmaCare Plan G. Patients currently registered with Plan G for coverage of OAT medications may incur out-of-pocket costs for M-ESLON® if they have not reached their Fair PharmaCare deductible for regular prescription drug benefits. Prescribers will not know their patient’s coverage at point-of-care. This issue will need to be addressed at a higher level if KADIAN® becomes unavailable.
  • An example prescription is provided below:

   

 

NOTE: As the current CPBC Professional Practice Policy #66 advises that only KADIAN® should used for OAT, prescribers can also note “b/c Kadian in shortage” to ensure the prescription is accepted and filled by the dispensing pharmacy.

 

OPTION 2 – Convert Patients to Methadone

  • Start individuals on methadone 30 mg a day and consult the RACE Line for support as needed (M-F 0800-1700; 604-696-2131 or 1-877-696-2131; Press 1 for addiction medicine)
  • See BCCSU Guideline for the Clinical Management of Opioid Use Disorder for more information on transitioning from SROM to methadone
  • Convert patients back to once-daily dispensed KADIAN® when the shortage is over

 

Jan 10, 2018