Some 25 mil­lion die in pain each year: re­port

The Daily Star (Lebanon) - - WORLD -

Ev­ery year, some 25 mil­lion peo­ple – one in 10 of them chil­dren – die in se­ri­ous pain that could have been al­le­vi­ated with Mor­phine at just a few cents per dose, re­searchers said Fri­day.

This rep­re­sents nearly half of all deaths glob­ally each year, they re­ported in The Lancet med­i­cal jour­nal, warn­ing of a “global pain cri­sis.”

The chal­lenge is to im­prove pal­lia­tive care in low-in­come coun­tries while avoid­ing mis­takes that led to the U.S. ad­dic­tion cri­sis.

Ac­cord­ing to the re­port one key is us­ing off-patent Mor­phine that costs pen­nies a dose – not prof­itable for drug com­pa­nies that push pricier, more pow­er­ful opi­oids in rich coun­tries, but crit­i­cal to eas­ing a health emer­gency.

In some places, even chil­dren dy­ing of cancer or chil­dren in treat­ment for cancer can’t get pain re­lief, Uni­ver­sity of Mi­ami pro­fes­sor Feli­cia Knaul, said. She co-chaired a Lancet-ap­pointed in­ter­na­tional com­mis­sion that spent three years study­ing the dis­par­ity and what she calls “the moral obli­ga­tion” to help.

“This re­port fi­nally gives voice to the suf­fer­ing and a road map to gov­ern­ments,” Knaul said.

How much is needed? The Lancet Com­mis­sion pro­vided the first global es­ti­mates of the need for pal­lia­tive care, de­fined as “se­ri­ous healthre­lated suf­fer­ing” from cer­tain lifethreat­en­ing con­di­tions, in­clud­ing cancer, HIV and trauma.

Some 2.5 mil­lion chil­dren are among the an­nual count of nearly 26 mil­lion who die with­out ad­e­quate re­lief, the team cal­cu­lated.

Another 35.5 mil­lion peo­ple a year have se­ri­ous pain and suf­fer­ing from those con­di­tions but aren’t dy­ing, and most live in low- or mid­dle-in­come coun­tries.

The world’s poor­est coun­tries have ac­cess to enough Mor­phine to meet less than 2 per­cent of their pal­lia­tive care needs, the re­port found. In­dia fares lit­tle bet­ter, at 4 per­cent; China meets 16 per­cent of its need, and Mex­ico 36 per­cent.

The 2010 earth­quake in Haiti high­lighted the scarcity, as doc­tors lacked opi­oids for peo­ple who were se­verely in­jured or needed surgery, the com­mis­sion noted.

Be­yond painkillers, the panel urged health sys­tems to make avail­able an “es­sen­tial pack­age” of pal­lia­tive care ser­vices that also in­cludes med­i­ca­tions to ease breath­ing prob­lems, mus­cle spasms, com­pli­ca­tions of heart or liver fail­ure, and de­pres­sion and psy­cho­log­i­cal suf­fer­ing. The list also in­cludes prac­ti­cal equip­ment like pres­sure sore-re­duc­ing mat­tresses, adult di­a­pers – and a lock box for any needed Mor­phine.

The Lancet panel looked to lessons from the U.S. opi­oid cri­sis, and from West­ern Europe, which has avoided sim­i­lar abuse thanks to strict opi­oid mon­i­tor­ing and to univer­sal health cov­er­age for nono­pi­oid treat­ments for chronic pain, said re­port co-au­thor Dr. Lukas Rad­bruch, a pal­lia­tive care spe­cial­ist at Ger­many’s Uni­ver­sity of Bonn. Among the rec­om­men­da­tions:

Coun­tries should use cheap, im­me­di­ate-re­lease oral and in­jectable Mor­phine for se­vere pain. Clos­ing the pain gap would cost $145 mil­lion.

Don’t al­low drug com­pany mar­ket­ing to pa­tients, physi­cians or other health care providers. In the U.S., pre­scrip­tions soared af­ter mar­ket­ing of newer opi­oids for less se­vere types of pain.

Closely mon­i­tor Mor­phine sup­ply, and train health work­ers in proper pain treat­ment.

The $1.5 mil­lion study was funded by the Uni­ver­sity of Mi­ami and Har­vard Uni­ver­sity and with grants in­clud­ing from the U.S. Na­tional Cancer In­sti­tute, Amer­i­can Cancer So­ci­ety and drug­maker Pfizer. Another drug com­pany, Roche, pro­vided a grant to help the Uni­ver­sity of Mi­ami dis­sem­i­nate the find­ings.

One spe­cial­ist said the pro­posal for poor coun­tries to avoid patented opi­oids was a “sen­si­ble” ap­proach.

Still, “I wish they had in­cluded a stronger warn­ing re­gard­ing the risks of a pain man­age­ment agenda be­ing co-opted by profit-seek­ing phar­ma­ceu­ti­cal com­pa­nies as it was in the United States,” Stan­ford Uni­ver­sity psy­chi­a­try pro­fes­sor Keith Humpreys said. –

Newspapers in English

Newspapers from Lebanon

© PressReader. All rights reserved.