25 mil­lion peo­ple die in agony each year with no ac­cess to mor­phine

The Guardian - - INTERNATIONAL - Sarah Bose­ley Health ed­i­tor

More than 25 mil­lion peo­ple, in­clud­ing 2.5 mil­lion chil­dren, die in agony ev­ery year around the world for want of mor­phine or other pal­lia­tive care, an in­ves­ti­ga­tion has found.

Poor peo­ple can­not get pain re­lief in many coun­tries be­cause their needs are over­looked or the au­thor­i­ties are so wor­ried about the po­ten­tial il­licit use of ad­dic­tive opi­oids that they will not al­low their im­por­ta­tion.

“Star­ing into this ac­cess abyss, one sees the depth of ex­treme suf­fer­ing in the cruel face of poverty and in­equity,” says a spe­cial re­port from a com­mis­sion set up by the Lancet med­i­cal jour­nal.

In Haiti, for in­stance, says the re­port, there are no nurs­ing homes or hos­pices for the dy­ing and most have to suf­fer with­out pain re­lief at home. “Pa­tients in pain from trauma or ma­lig­nancy are treated with med­i­ca­tions like ibupro­fen and ac­etaminophen,” says tes­ti­mony from An­to­nia P Eys­sal­lenne of the Uni­ver­sity of Mi­ami School of Medicine. “More­over, nurses are un­com­fort­able giv­ing high doses of nar­cotics even if or­dered to do so for fear of be­ing ‘re­spon­si­ble’ for the pa­tient’s death, even if the pa­tient is ter­mi­nal.

“Death in Haiti is cruel, raw, and dev­as­tat­ingly pre­ma­ture. There is often no ex­pla­na­tion, no sym­pa­thy, and no peace, es­pe­cially for the poor.”

The com­mis­sion’s three-year in­quiry found that nearly half of all deaths glob­ally – 25.5 mil­lion a year – in­volve se­ri­ous suf­fer­ing for want of pain re­lief and pal­lia­tive care. A fur­ther 35.5 mil­lion peo­ple live with chronic pain and dis­tress. Of the 61 mil­lion in to­tal, 5.3 mil­lion are chil­dren. More than 80% of the suf­fer­ing takes place in low and mid­dle-in­come coun­tries.

Mor­phine is hard to ob­tain in some coun­tries and vir­tu­ally un­ob­tain­able in oth­ers. Mex­ico meets 36% of its need, China 16%, In­dia 4% and Nige­ria 0.2%. Oral and in­jectable mor­phine is out of patent, but costs vary widely and it is cheaper in af­flu­ent coun­tries than in poor ones. A sec­ond is­sue is “opio­pho­bia” – the fear that al­low­ing the drugs to be used in hos­pi­tals will lead to ad­dic­tion and crime in the com­mu­nity.

“The world suf­fers a de­plorable pain cri­sis: lit­tle to no ac­cess to mor­phine for tens of mil­lions of adults and chil­dren in poor coun­tries who live and die in hor­ren­dous and pre­ventable pain,” says Prof Feli­cia Knaul, co-chair of the com­mis­sion, call­ing it “one of the world’s most strik­ing in­jus­tices”.

Knaul says she only re­alised that many peo­ple suf­fered with­out pain re­lief when she was work­ing to im­prove ac­cess to cancer treat­ment in low-in­come coun­tries. “I was shocked. I had no idea. When peo­ple were show­ing me the data I thought it can’t be in this world,” she told the Guardian.

She had also ex­pe­ri­enced the need for mor­phine her­self af­ter a mas­tec­tomy. “When I woke up I couldn’t breathe be­cause the pain was so bad. If they hadn’t ar­rived with the mor­phine I don’t know how I would have got through it.”

“I don’t think we have cared enough about poor peo­ple who have pain,” she said. “It doesn’t make them live any longer. It doesn’t make them more pro­duc­tive. It is sim­ply the hu­man right of not suf­fer­ing any more pain and we don’t care about that for peo­ple who are poor.”

The com­mis­sion rec­om­mends that all coun­tries put in place a rel­a­tively in­ex­pen­sive pack­age of ef­fec­tive pal­lia­tive care for end-of-life con­di­tions that cause suf­fer­ing, in­clud­ing HIV, can­cers, heart dis­ease, in­juries and de­men­tia.

One of their most em­phatic rec­om­men­da­tions, says Knaul, “is that im­me­di­ate-re­lease, off-patent mor­phine that can cost just pen­nies should be made avail­able in both oral and in­jectable for­mu­la­tions for any pa­tient with med­i­cal need.”

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