Thousands of cancer patients are being forced to spend their final days sitting in medical waiting rooms trying to source alternative pain relief because of a critical nationwide shortage of a major drug.
Targin is a slow-release oxycodone and naloxone combination often prescribed to cancer patients in the palliative stages and chronic pain sufferers to reduce severe pain.
But stocks have dwindled due to issues with shipping lines and flight availability.
"These patients don't want to spend what limited time they have left at the hospital on the phone to doctors, in waiting rooms, trying to get prescriptions," north Queensland pharmacist Cate Whalen said.
A scary trip
For Nadine Cluff, the medication helped her get through the days in the lead-up to Christmas after she was diagnosed with stage 4 lung cancer.
"These pains were just intensifying all the time which led me to go onto Targin," she said.
"I was really living from pill to pill. This was the only thing that made me able to function through the day."
The 37-year-old from Clermont in central Queensland started 2021 as a fit and healthy woman, but by September she was bedridden due to the pain caused by the cancer growing inside her body.
"When you are feeling pain really nothing seems to be working for you and you need that bit of freedom to be able to feel like yourself again," she said.
"If you are constantly managing pain it really just draws you down."
She was shocked to discover the shortage when she asked her doctor for a new script and tried to get it filled in Townsville.
While regular radiation and chemotherapy treatments in Townsville have helped reduce her pain for now, Ms Cluff is concerned about what the shortage could mean long-term.
"It's a scary trip the cancer trip at the best of times, and to not be able to get the basic things to fight it, to feel like a better person, not having a supply, it's just not right," she said.
"It's not right for so many people on many different levels."
Finding alternatives
Dr Abhishek Joshi is a medical oncologist at Townsville ICON Cancer Care and Townsville University Hospital.
He said his clinic saw about 1,000 new patients each year and the shortage would affect about half of them.
"Patients might now have to undergo a period ranging from days to weeks in which their pain levels might actually fluctuate and start affecting their lifestyle."
Dr Joshi said it was the first time he had seen a shortage of Targin.
"I know regional towns are not the preference sites where these stocks are channelled, mostly bigger cities and metros are much more advantaged," he said.
Apology to patients
Unlike many other drugs on the market, Targin does not have a suitable substitute.
The Therapeutic Goods Association (TGA) said it was hoping supplies would be replenished in April, but that had already been delayed to the end of May.
In a statement, the provider of the drug, Mundipharma Pty Ltd, apologised to patients, doctors, and customers for the supply disruption.
"We are in close contact with shipping and air carriers to ensure freight prioritisation for these critical medicines."
Cate Whalen said it had been very distressing for customers at her chemist.
"I think people are getting a bit tired and a bit at the end of their rope," she said.
"All strengths of Targin are affected.
"Initially, for example, if the 20 milligrams went out, doctors were prescribing 10 milligrams and giving them twice as much. But that's cascaded so now all the strengths are unavailable and now there is no equivalent.
"It's not ideal as far as their treatment goes because it's not like you can just swap a brand or a strength, and these people are using these high pain threshold drugs for quite chronic conditions so we don't really want to mess with it.
It is little comfort for people like Nadine Cluff who are battling through every day.
"Cancer doesn't get better, it doesn't go away on its own accord," she said.
"You have to be fighting it, and to do that you have to be an able-bodied person and you need to not feel that pain."
