In a comprehensive report on palliative care and pain relief published 13 October in The Lancet, the study says that each year, some 26 million people, including over 2.5 million children, suffer pain which could have been addressed with off-patent, low-cost morphine.
The report says that of the 298.50 tonnes of oral morphine distributed worldwide, only 10.8 tonnes (3.6 per cent) reach the low- and middle-income countries, creating a “pain gap”. Of the 172 countries studied, 25 had almost no morphine and about 100 countries are only able to meet the needs for standard pain relief of a quarter of their population.
“The question is how to strike a balance between dangerous drugs and access for palliative care purposes”
Lukas Rudbruch, chair of the Palliative Medicine at the University of Bonn and senior co-author of the report, explains to SciDev.Net that there are serious misunderstandings about the nature of palliative care, including stigma attached to pain-relieving drugs. This, he says, is especially so for morphine (derived from opium) which makes regulators and health professionals uneasy.
Former Philippine health secretary Manuel Dayrit explains that in countries like the Philippines, morphine is classified as a ‘dangerous drug’, with supply and transport highly regulated. Only physicians with special permits can prescribe them.
“The question is how to strike a balance between dangerous drugs and access for palliative care purposes,” Dayrit says.
Rudbruch, who is also chair of the International Association for Hospice and Palliative Care, says physicians in general are focused on cures and saving lives, neglecting care giving or relieving pain.
“Advance cancer and other life-threatening diseases and certain conditions (such as accidents and acute trauma) are often related to severe pain,” Rudbruch says. “Morphine is often associated with the terminally-ill, but patients may need opioids (drugs for pain relief) through treatments that can go on for years. In addition, there are non-life threatening conditions, like chronic lower back pain, that call for opioids for the patient to lead a normal life.”
Rudbruch emphasises that while morphine is cheap and can be produced locally in developing countries, it is still not readily available.
According to the report, China has enough opioid analgesic to meet the needs of only 16 per cent of those who need it. The Philippines cover only about 8 per cent, Indonesia 4.2 per cent, India 4 per cent and Pakistan 1.5 per cent. In contrast, the US has an opioid epidemic. Benjie Reyes, undersecretary and permanent board member of the Philippine Dangerous Drugs Board, says that the government actually dispenses morphine in state-run hospitals for free so access should not be an issue.
“We addressed the regulatory roadblocks and even removed the requirement for the special form so that doctors can prescribe them for people who need them. But physicians are either not prescribing morphine or prescribing very expensive opioids,” says Reyes.
“I suspect a lot of doctors are misinformed or have poor knowledge of pain management. This is something that the school system should address,” he adds.
This piece was produced by SciDev.Net’s Asia & Pacific desk.