Palliative drug available only in cities, denying access to patients in the districts

Cancer patients in most districts of the State are left to suffer excruciating pain due to lack of access to effective and inexpensive pain reliever, Morphine, despite amendment of the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985.

Amendments to the NDPS Act, which promise to make the drug accessible to all cancer patients, have failed to ensure delivery of the crucial drug in peripheral centres in the State. “Patients are denied essential treatment and have no access to the drug due to lack of awareness and misconceptions among physicians and even specialists regarding the use of morphine,” said Dr. G. Durga Prasad, in-charge of Department of Pain and Palliative Care, MNJ Cancer Institute, on the occasion of Cancer Survivors Day.

The NDPS Act requires licences from several agencies to procure every consignment of the drug making it inaccessible. Oncologists said that the drug is only available in cancer hospitals in cities due to stringent policy regulations and that cancer patients in districts are forced to come to the city to procure morphine.

“While morphine is recommended as essential first-line treatment,” Dr. Prasad said, “alternatives of the drug such as Fentanyl, which are transdermal patches, cannot be used as first-line treatment and are not recommended as they produce erratic results due to sweat on the skin's surface.”

Morphine is also the least expensive and most effective palliative drug. Dosage of the drug for a day costs not more than Rs. 18, while doctors said that alternatives such as Fentanyl cost over Rs. 150 for a day and are easily available as they pushed forward by pharmaceutical companies. Oncologists also said that morphine targets multi-dimensional aspects of pain in majority patients and that other methods of pain alleviation such as nerve blocks target only one particular area and in course of time cause the disease to progress beyond the area of innervation.

Fear of misuse

While the State effected amendments to the act two years ago, there is still fear of misuse and misconceptions about the addictive nature of Morphine. “For over three decades, medical education in the aspect of palliative care has been almost absent. Hospital administrators or pharmacists do not understand the essential nature of pain treatment and use of morphine and so do not stock it,” said Dr. Prasad.

While India is the largest producer of opium for pharmaceutical trade, from which Morphine is obtained, 90 per cent of it is exported and a mere 4 per cent is available for needy cancer patients in the country. “While over 50 per cent of cases of cancer are being detected in its advanced stage, where pain is the most common presenting symptom, limited access of the drug Morphine is causing many to die of unbearable pain,” said Dr. P Raghu Ram, Director Oncoplastic Breast Surgeon, KIMS-Ushalkakshmi Centre for Breast Diseases.

“Urgent policy regulations to make the drug easily accessible are required,” he added.