More than 25.5 million people, including 2.5 million children, globally die every year with serious health suffering that requires palliative care. A sixth of these people, who need palliative care, are in India. But only a tiny minority of such patients in the country has access to basic pain relief or palliative care
This inequity in access to essential pain relief and palliative care is one of the world’s most striking injustices, says The Lancet , in its latest report, ‘Alleviating the access abyss in palliative care and pain relief — an imperative of universal health coverage”.
The study, commissioned by The Lancet , was conducted by the Commission on Global Access to Palliative Care and Pain Relief. The report will be released on the occasion of World Palliative Care Day on October 14.
M.R. Rajagopal, one of the five lead authors of The Lancet study and the chairman of Pallium India, said despite announcing a national programme for palliative care in 2012, India had made negligible progress in providing palliative care in the past five years.
“The draconian Narcotic Drugs and Psychotropic Substances Act, which was a major hindrance to access to pain relief, was amended by Parliament in 2014. Yet, most Indian States have not implemented the revised law. Even basic pain management and principles of palliative care are still not being taught to medical and nursing students,” says Dr. Rajagopal.
The study says off-patent, inexpensive, oral morphine for pain relief costs as little as 3 cents per 10 mg. Yet, less than 1% of the world’s supply went to low-income countries where the need is the greatest.
Severe under-treatment of pain is reported in more than 150 countries, accounting for about 75% of the world’s population. At least 5 billion people live in countries affected by the crisis of under-consumption, and more than 18 million annually die with treatable pain.
The Lancet study provides the first worldwide estimates of serious, health-related suffering and the resultant need for palliative care and pain relief.
It says the number of people who experience serious health-related suffering is much higher, with an additional 35.5 million requiring pain relief outside of end-of-life care.
Global policies restricting access to opioids mean that millions of people are denied medicines to relieve pain linked to illness or injury.
The authors of the study have developed an essential package of palliative care services — including medicines, equipment and staffing models — to be made available by health systems worldwide.
They have called for more balanced global policies to facilitate access to opioid analgesics to meet medical need, while limiting non-medical use.
