The reason for developing the ANZCA EML
Drug supply is vulnerable to disruption from a number of causes, and impacts clinical care in a number of ways:
- Market forces may drive hospital, regional or national purchasing decisions which affect the presentation (appearance, concentration, excipients) of the same active drug
- Supply chain vulnerabilities for a given drug may require an alternative presentation of that active drug from a different supplier, including the use of special access schemes to enable importing and use of that drug event if it is not registered (eg on the Australian Register of Therapeutic Goods).
- Supply chain vulnerabilities for a given active ingredient may require an alternative pharmaceutical to be used which has a similar effect. This alternative may already be registered for that indication or require special access arrangements.
In cases of severe disruption of critical drugs, changes in clinical practice may be required to accommodate the need to deliver necessary clinical care.
Essential Medications Lists (EMLs) have been developed for a number of purposes by different jurisdictions and organisations. Currently there exists no EML that is focussed on the needs of both anaesthesia and pain medicine in Australia and New Zealand. The closest resource is the National Essential Anaesthesia Drug List (NEADL) produced by the Association of Anaesthetists (Great Britain & Ireland) (AAGBI). ANZCA is grateful to the AAGBI for permission to draw heavily on the structure and relevant content in developing this resource.
The aim of the ANZCA EML is to inform decision makers at all levels in planning when shortages are imminent, or alternative supply sources are being considered. This includes – practitioners, departments, hospital pharmacies, procurement, hospital groups or regional supply networks, and national levels – including the Therapeutic Goods Administration (TGA) and MedSafe. It aims in particular to provide a central resource that departments can use to plan drug supply and share with their pharmacies, especially in times of shortage.
The issues of safety related to drug substitution (eg look alike ampoules) has been highlighted in ANZCA safety alerts and bulletin articles and would be re-enforced in the covering webpage.
The ANZCA-EML is intended to be advisory and not be prescriptive. It should be emphasised that individual clinical circumstances and clinician responsibility determine medication use on any given occasion.
Updates will occur to the ANZCA EML when and as required.
Related resources
The TGA has a useful resource related to managing supply and alternative drug access on its website.
Essential Medicine Lists from a number of sources have been considered in the development of the ANZCA-EML. These include:
- the World Health Organisation (WHO Model List of Essential Medicines)
- the TGA (Therapeutic Goods (Reportable Medicines) Determination 2025)
- the Association of Anaesthetists GB and Ireland (National Essential Anaesthesia Drug List (NEADL) 2021)
- the US Food and Drug Administration List of Essential Medicines
In addition, ANZCA includes a list of Emergency Medications (PS55 Minimum Requirements Appendix 1), however these are focussed on emergency situations, not routine care.
Apart from the NEADL (and PS55), the above sources do not focus on the needs of anaesthesia and pain medicine.
Development
Current version (June 2026)
Development group:
Prof David A Scott (DPA-Policy)
Dr Michelle Mulligan (DPA-Policy)
Consultation and feedback:
Dr. Sally Ure (Councillor, NZ)
Dr Nicole Sheridan (chair Obstetric SIG),
Dr Tanya Farrell (chair, SPANZA)
ANZCA Safety and Quality Committee
Update schedule: The ANZCA-EML will be updated when necessary based on new information, medication availability and feedback.