Around 26 million people die every year in serious pain without morphine tablet, says report

New Delhi: Nearly 26 million people die every year worldwide in serious pain without a three-cent morphine tablet and almost every 10th mortality is that of a child, researchers said on Friday. India - among eight of the largest global populations - was meeting the needs of just four percent of those requiring pain relief, The Lancet medical journal reported warning of a “global pain crisis”. More than 75 percent of the world’s population lives in countries that provide less than half of the morphine needed for palliative care. [caption id=“attachment_2566590” align=“alignleft” width=“380”] Representational image. Reuters[/caption] The crisis can be solved easily through an essential package of palliative care to be made available by health systems worldwide. According to the report, the most comprehensive global analysis of palliative care, some 61 million people world over suffer serious physical and psychological suffering and pain each year. Of this total, some 83 percent live in low and middle-income countries where access to low-cost, off-patent morphine is rare or completely unavailable, even though the cost should be pennies a tablet. The annual burden in days of severe physical and psychological suffering is huge – six billion days worldwide, 80 percent in the low and middle-income countries, according to The Lancet Commission on Global Access to Palliative Care and Pain Relief, which studied this health issue for three years. Of the 298.5 metric tonne of oral morphine distributed worldwide, only 10.8 metric tonne, 3.6 percent, go to low and middle-income countries. “The pain gap is a massive global health emergency which has been ignored, except in rich countries,” an official statement quoting Felicia Knaul, chair of The Lancet Commission and Professor at the Leonard M. Miller School of Medicine at the University of Miami, said. This global pain crisis has relief too! The Lancet Commission calls for an essential package of palliative care to be made available by health systems worldwide. At the centre of the essential package is immediate release, oral and injectable morphine. In high-income countries, a pain-relieving dose costs three cents per 10 mg. In the low-income nations, the same morphine cost 16 cents where and when it is available. For Julio Frenk, co-author and President of the University of Miami, the results are startling. “The pain gap is a double-edged sword with too little access to inexpensive opioids for poor nations and misuse by the rich ones. The enormous disparity between need and availability of opioids for palliative care is growing and skewed against people living in poverty,” Frenk said. Pain reliever opioid is a compound resembling opium in addictive properties or physiological effects. The major problem is in eight of the countries with the largest global populations. China has enough opioid analgesic to meet the needs of only 16 percent of those needing pain relief; India four percent; Indonesia 4.2 percent; Pakistan 1.5 percent; Nigeria 0.2 percent; Bangladesh 3.9 percent; Russia eight percent; and Mexico 36 percent. Brazil has enough for almost 75 percent who need it. Among the 10 most populous nations, only the US has the opposite problem – an opioid epidemic. Of the 172 countries studied, 25 had essentially no morphine, while a further 15 had enough to meet less than one percent of pain relief requirements. “To improve the usefulness of the report, we used case studies and examples how individual countries overcame individual problems,” Lukas Radbruch, another co-author and Chair of Palliative Medicine at the University of Bonn, said. India is among the countries that solves palliative care delivery problems. In Kerala, a single program expanded into a network of 841 palliative care sites and prompted the design of palliative care policies in other states, said the report. In Nepal, where morphine was virtually unavailable, a local doctor convinced a Nepalese pharmaceutical company to produce oral morphine locally and to distribute it at cost to hospitals as a humanitarian gesture. Experiencing the pain of cancer, Knaul, who is also the Director of the Institute for Advanced Study of the Americas, added: “I have accompanied a loved one dying in the pain of cancer. No human being should go through this without pain medicine.”