'Free' Morphine in India Not Available to Many Who Need It
Originally published by Reuters Health, March 12, 2002
NEW DELHI — While oral morphine is available at no cost to cancer patients in India, the vast majority of patients are not able to obtain the drug because of stringent bureaucratic regulations.
"There are a million Indians in severe unrelieved pain from cancer and a huge number of other incurable diseases, including HIV-AIDS," Dr. M. R. Rajagopal, Professor of Pain and Palliative Care at Calicut Medical College told the Pan Asia Cancer Conference here last week.
"Despite the free availability of very cheap oral morphine in India, a million people are still not getting this medication, while huge quantities are sold and exported abroad so that people there can get pain relief," Dr. Rajagopal told Reuters Health.
"Roughly 56% of cancer patients in our experience need opioids in some form or other at various stages," Dr. S. H. Advani, head of medical oncology at Tata Memorial Hospital, Mumbai told Reuters Health. "There are some data which suggest that cancer pain by itself could have an impact on survival of the patient," he added.
"In our clinic, at least 54% patients get effective pain relief only from morphine while other alternatives, including weak opioids, are not enough," stated Dr. Rajagopal, who also heads the Palliative Care Society of India and WHO's demonstration project in palliative care in southern India. "Only 3% of the needy patients in India have actual access to oral morphine," he said.
Dr. Rajagopal said that major reasons for non-availability are misconceptions about the risk of addiction and stringent narcotic regulations on the part of public health officials.
The anti-narcotics bureaucracy demands stringent controls and paperwork. The punishments for narcotic offences under Narcotics Control Act are harsh in India and could send the offender to several years of imprisonment or unnecessary harassment even for a minor offense.
Hospitals, therefore, do not want to store big quantities of narcotics, Dr. Rajagopal pointed out. Small quantities are manageable because fewer records need to be kept and there is less chance of theft, he said. If quantities are larger and every tablet has to be accounted for, the loss of a few tablets and the ensuing problems could wreak havoc on institutions and officials, the palliative care expert noted.
Under lobbying from experts, 7 Indian states out of some two dozen eased their stringent regulations in the past two years, but it has made little difference overall in India. Three out of these 7 states still have limited effective palliative care for their cancer patients despite paper reforms.
