Ministry of Public Health concerned at erroneous impression that oral morphine can be given without necessary control measures

Dear Editor,

With reference to a Stabroek News article captioned `Cancer patients suffering due to lack of access to oral morphine Beacon Foundation head’ published on October 15 2019, in which the President of that foundation is reported to have said that the organization’s inability to access oral morphine through the Ministry of Public Health has resulted in many of its cancer patients suffering in pain, the Ministry would like to clarify the issue.

The Ministry as a part of its free public health programme provides care and treatment to all cancer patients throughout Guyana at Public Health Facilities in accordance to the norms, standards and regulations governing health care services. Under these conditions the Ministry and the public health facilities routinely provide all the diagnostic and chemotherapy services needed by persons affected by cancers. The Ministry in addition partners with the Cancer Institute of Guyana, private hospitals, private practitioners and to some extent Beacon Foundation in facilitation of radiation treatment and some aspects of palliative and home care for patients with cancers.

The Ministry through the Chief Medical Officer (CMO) has an arrangement in place for the provision of available narcotics substances (including all forms of Morphine) and other pain management medication based on the established regulation of these controlled substances. The CMO therefore will provide these medications based on the existence of the correct conditions for safe and efficacious administration of all narcotic substances.

Guyana, on July 15 2002 became a signatory to the Single Convention on Narcotics Drugs, 1961 and as such falls within the regulatory framework of the convention. As a party to the convention, Guyana assesses all necessary narcotic medication based on an assigned quota. The obligation by the Government of the Cooperative Republic of Guyana, represented by the Ministry of (Public) Health requires that an approved system for importation, storage, sale, use in manufacturing and as treatment of all accessed narcotic drugs must be regulated. The provisions further specify that for clinical use, all narcotic drugs must be prescribed by a fully registered medical practitioner, dispensed by a registered pharmacist and administered by a registered nurse.

Further, the “Yellow List” of Narcotic Drugs Under International Control as defined by the Protocol of 25 March 1975 amending the Single Convention on Narcotic Drugs, 1961 list in Part 1 lists all morphine containing tablets (morpheridine, morphine, morphine methobromide, morphine-n-oxides and all other derivatives of morphine and codeine) as controlled drugs.

It is therefore clear that all morphine preparations are governed by these provisions. The Ministry is cognizant of the fact that prescription medicine abuse is a growing problem and like with other regulated medicines that are availably freely on the market like antibiotics misuse can lead to dangerous resistance and in the case of narcotics, devastating addictions.

On the matter of short supplies, the Ministry will like to additionally inform that due to the expanded range of clinical services including more advanced surgical procedures and palliative care throughout Guyana, the Minister of Public Health had submitted an application in 2018 to the International Narcotic Control Board for an increase in the annual quota for Guyana of narcotics and to expand the range of such items both in chemical compound and formulation (injectable, tablets, liquid and other forms).

The Ministry is therefore, concerned by the statements of the Beacon Foundation which erroneously gives the impression that oral morphine can be given without the necessary control measures in-place in violation of the obligation of the state.

The Ministry is seeking a retraction of these damaging public statements and wishes to appeal to all its partners including the Beacon Foundation to support the efforts of the Government by bringing to the attention of the Chief Medical Officer any issues they may have regarding the delivery of quality health care to members of the public.

The Ministry assures members of the public, including persons affected by cancers that it will do all that is necessary and essential to ensuring that there is access to high quality health care which is safe and free from any risk or complication to the society.

Yours faithfully, Dr. Shamdeo Persaud Chief Medical Officer