Mil­lions die suf­fer­ing amid global opi­oid gap, re­port says

Sun.Star Pampanga - - HEALTH! -

ASHINGTON (AP) — Nearly 26 million peo­ple the world die each year with se­ri­ous suf­fer­ing in part be­cause of a huge gap in pain re­lief: The U.S. may be awash in opi­oid painkillers, but they’re rare or unavail­able in dozens of poor coun­tries, says a new re­port.

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

The re­port to be pub­lished Fri­day in The Lancet says 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, said Univer­sity of Mi­ami pro­fes­sor Feli­cia Knaul. 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 roadmap to gov­ern­ments,”Knaul said.

Of the few hun­dred tons of mor­phine and equiv­a­lent opi­oids dis­trib­uted world­wide, less than 4 per­cent goes to low- and mid­dle-in­come coun­tries, the re­searchers re­ported.

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 life-threat­en­ing 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 per cent .

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 sor­ere­duc­ing mat­tresses, adult di­a­pers — and a lock box for any needed mor phine.

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 non-opi­oid 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 pai n.

— 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 drug maker Pfizer. Another drug com­pany, Roche, pro­vided a grant to help the Univer­sity of Mi­ami dis­sem­i­nate the find­ings.

One spe­cial­ist who has long warned that the U.S. ad­dic­tion cri­sis could spread in­ter­na­tion­ally said the pro­posal for poor coun­tries to avoid patented opi­oids was a “sen­si­ble” appr oach.

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