The article by Luty (Reference Luty2005), together with the two commentaries (Reference CarnwathCarnwath, 2005; Reference GilvarryGilvarry, 2005), does much to reveal the intricacies of the debate concerning injectable diamorphine prescribing. Unfortunately, none of the articles mentions the fact that since December 2004 supplies of injectable diamorphine in the UK have been diverted away from addiction services due to a failure in production at the plant of the main manufacturer: Chiron.

In Cornwall we had 51 clients in receipt of such a prescription, all of whom had already been tried on optimised methadone maintenance, and two-thirds of whom were stable and not using street drugs. When the shortage started to affect our local pharmacies, 43 of these clients were converted to a part-injectable methadone prescription. All 43 complained of side-effects and, using a questionnaire, keyworkers identified other ‘serious undesirable consequences’ in 41, with 35 clients admitting to increasing or restarting street heroin use. Clients who were not switched to methadone had diamorphine solution or tablets, or higher strength ampoules, which were on the whole much better tolerated.

The experience has confirmed to local clinicians the value of diamorphine by whatever route, particularly in those that do not tolerate methadone well.

The disruption that has been caused by the supply failure has been considerable and we have been disappointed that the Department of Health appears to have had so much difficulty in procuring adequate additional supplies, or even in giving a reliable date as to when normal supplies will return. This uncertainty is adding considerably to the ongoing difficulty of planning safe and effective treatment for our clients.