Morphine available to just 1% cancer sufferers

Patients Hope Parliament Will Pass Change In Narcotic Law For Pain-Free Access To Drug

When the winter session of Parliament begins on December 5, millions of cancer patients hope lawmakers will clear a long-awaited amendment that will allow them easier access to morphine. 

    Morphine, one of the best known pain-control medicines, is available to barely 1% of all patients suffering from pain arising out of their cancer or HIV/ AIDS infection, say experts. "India has 2.4 million cancer patientswho need pain relief and another 2.5 million living with HIV. These patients sometimes suffer unbearable pain that is best relieved by morphine," said Thiruvananthapurambased Dr M R Rajagopal, often referred to as the father of palliative care in India. 
    Last two sessions of the houses failed to take up the amendment to the Narcotic Drugs and Psychotropic Substances Act, 1985. Dubbing its poor access as a human rights violation, Dr Rajagopal said, "We hope the amendment will be passed this time.'' 
    Morphine is classified as a narcotic under the NDPS Act, resulting in tight restrictions to prevent its misuse. The law states that anybody found with 250 grams of morphine without adequate licences could face up to 10 years of rigorous imprisonment. 
    This lack of access to morphine for patients, though, is not limited to India alone. Untreated cancer pain is a scandal of global proportions, said a new research published in the Annals of Oncology a few days ago. The report worked out by the Global Opioid Policy Initiative showed that half of the world's population lives in countries where regulations that aim to stem drug misuse leave cancer patients without access to opioid medicines for managing cancer pain. 
    Kerala and Maharashtra are two states in India that use morphine more than the rest of India for their cancer patients. "Yet, we can safely say that the patients need 10 times more morphine than is being used at present,'' said Dr Mary Ann Muckadam, professor at Tata Memorial Hospital in Parel, which offers palliative care to 3,500 patients a year. "But 66% of our patients come from outside the state and less than 10% of these stay on to access pain medication." 
    The story in the rest of India is sadder. "Half of the regional cancer centres don't have morphine or doctors trained in using it. This, despite the fact that 70% of their patients come with advanced cancer,'' said Dr Rajagopal. 
    Experts are convinced that better access to morphine will change the plight of Indian cancer patients. "In 1985, India had used over 700kg of morphine for patients. This number fell drastically to 18kg in 1997—just a few years after NDPS came into existence,'' said the doctor. 
    At present, India uses a little over 200kg for its patients. 
IACA to fund training of doctor-nurse teams in palliative care 
    For the past few years, Tata Memorial Hospital in Parel has been running pain management programmes in Jawahar and Igatpuri districts to show how a small team—a social worker and a nurse—can help. "We help 500 patients in these two districts,'' said Dr Mary Ann Muckaden of TMH. While the state government had promised to help set up more such teams across the state, funding has been an issue. Now, the Indian American Cancer Association (IACA) has come forward to fund the training of doctor-nurse teams in palliative care at five institutes (including TMH and Pallium India in Thirvananthapuram). "Patients needing palliative care cannot travel to cities for medication. We hence thought of training doctor-nurse teams from smaller cities and towns. We will help these teams set up palliative care programmes in their respective centres,'' said IACA's Kirti Jain.