Recommendation 50

HM Government · verbatim extract Rejected

The Government does not accept this recommendation. There are two UK suppliers of diamorphine, and both have experienced repeated manufacturing issues over the past five years due to the complexities of the manufacturing process. In response to the ongoing supply issues, following expert input, advice was issued to the NHS in February 2020 that morphine should be considered a first line treatment option. The UK is the only country that uses diamorphine for medicinal analgesic purposes. Diamorphine is metabolised to morphine and, in terms of analgesic efficacy and effect on mood, it has no clinical advantages over morphine by oral or subcutaneous/intramuscular routes. This advice has subsequently been reiterated to respond to further supply issues and usage of diamorphine has reduced in the NHS. We are in contact with both suppliers when there are supply issues and continue to update the NHS if there are any changes to the availability of diamorphine injections. We support the use of DAT supported by wrap-around psychosocial support. The impressive Middlesbrough DAT programme that we witnessed held benefits for both the public health and criminal justice sectors. We are most disappointed that joint local funding from both the health and criminal justice sectors could not be secured for the programme. That said, we recognise the cost of the programme and the difficult decisions that need to be made by local stakeholders when allocating funds to services. Given the rate of opioid-related deaths in England, it is not further consideration that is required from central government, it is swift action.