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