Bermuda has 'run out' of its annual stock of a powerful painkilling drug commonly used by cancer patients in the last months of life.
Stick-on Duragesic patches provide relief from chronic pain and are often used by terminally ill Bermudians to make their last days more comfortable.
But Bermuda's supply has run dry and under international licensing regulations health chiefs cannot request any more until January. The hospital still has a small quantity of the drug but it is being forced to ration usage and will only prescribe to it's own patients.
In the worst cases, non-hospital patients will have to switch from the patches, which last for three days and have fewer side effects, to round-the-clock morphine injections, administered every four hours.
Others could have to return to hospital to receive pain medication, rather than spending their last days at home with their families. In less severe cases alternative drugs can be prescribed.
The shortage was caused by a spike in demand for the patches after the U.S Federal Drug Administration issued a recall on another painkilling drug - Percocet - earlier this year.
Many doctors switched their patients from Percocet to Duragesic patches and stuck with them after they proved popular.
But the patches contain a potent narcotic called Fentanyl, which is on a list of controlled substances which require an international permit under the Geneva Convention.
The island could face the same problem next year as Bermuda would have had to apply to increase its allocation before July.
Dr. Brenda Davidson, Bermuda's Senior Medical Officer, said: "There was a glitch in the supply of Percocet and the doctors switched to prescribing Duragesic patches, which proved to be very successful, so the demand increased rapidly at that point.
"Unfortunately it contains Fentanyl which is a controlled drug. We have basically used up our allocation and what we do have goes to the hospital - it's not available in the pharmacies.
"We can ask for more but a the licence is quite restrictive. We would have had to do that before June and at that time we didn't realize there was going to be a run on this drug."
She said the island would not be able to increase its annual allocation until 2011. For now doctors are having to find alternatives.
Dr Donald Thomas, chief of staff at King Edward VII Memorial Hospital, said it was forced to prioritise its own patients when drug supplies were running low.
He accepted that this would mean some seriously ill patients, who were not hospital patients, would have to accept alternatives for the next few months, even if that meant the inconvenience of injections.
In the most extreme cases he said private physicians could contact the hospital in a bid to work something out. But he could make no guarantees for non-hospital patients.
He said the hospital was having to ration the drug for its own patients.
"We are low on supplies, if there is something else we can use, we use it. At the beginning of the year someone with lower back pain might have got it, in a shortage they are going to get some other kind of treatment..."
Judith Saltus, a nurse for PALS which cares for terminally ill Cancer patients in the community, said the patches were a convenient form of treatment because they only had to be replaced every three days and were more comfortable than injections.
She said they were generally used for patients in chronic pain, often in the last few months of life, who are unable to swallow.
When the patches run out alternative treatments have to be found.
"We have to use alternative treatments - sometimes that means having (morphine) injections, for some it means injections around the clock - every four hours."
She added that she did not, personally, have any patients on the patches at the moment.
