An ongoing study by Pallium India, Hyderabad Society of Palliative Care and Human Rights Watch points to the problem of under-treatment of pain in terminally ill patients due to lack of access to drugs and reinforces the importance of amendments to the Narcotic Drugs and Psychotropic Substances Act, 1985, that is pending before Parliament.
As some of the pain relieving drugs or opioids closely relate to heroin and other illicit drugs, their buying and selling is strictly regulated by some countries. This affects a whole class of medicines, some of which are on the WHO’s essential medicines list, such as methadone that is effective in treating severe pain and treats opioid addiction and fentanyl which is useful for anaesthesia, for post surgery pain relief and may be used in child birth, said Diederik Lohman, senior researcher with Health and Human Rights Division, Human Rights Watch.
According to the pain prevalence study, more than 90 per cent of patients suffering from pain from cancer or other incurable diseases have no access to morphine or equivalent opioids.
“While the main concern is how these are not misused, it often ends up affecting the public health need for access to these medicines. It becomes difficult for doctors to prescribe and patients to receive these medicines, as violations involve a mandatory prison term,” says Mr. Lohman.
While about 40 per cent of patients surveyed said pain interfered with their daily activity, 45 per cent said sleep was significantly or completely interrupted by pain and 30 per cent said pain affected their normal work and the ability to walk.
“Under the 1985 Act, the States and the Union Territories can develop their own regulations and a minimum of five permits are required. An annual quota is prescribed, each consignment of drugs requires fresh import permit for each state and an export license is required for each state sending out the drugs. To get all permits valid at the same time for both the buyer and seller becomes a challenge and the system creates a disincentive for pharmaceutical companies and state governments,” explained Mr. Lohman.
Amendments to the NDPS Act would create a single window clearance system for the purchase and sale of these drugs.
The study was conducted in four regional cancer centres in Ahmedabad, Cuttack, Hyderabad and Kolkata and surveyed 1707 patients.