Much-needed morphine in short supply

Procedural difficulties in the procurement of medical morphine are causing untold hardship to cancer patients

Underdeveloped palliative care units and the fact that they are not properly integrated into the health care system are causing untold hardship to cancer patients. This is at a time when end-stage cancer patients need medical morphine, an essential component of palliative care, to endure pain. But, procedural hassles in its procurement are leaving them suffer in silence.

Oncologists point out that palliative care wings at hospitals (both government and private) are not well developed. Distribution of morphine among patients involves obtaining permission from multiple government agencies, which results in inordinate delay and supply shortage. Lack of awareness among doctors, users and the authorities is another factor.

MNJ Cancer Hospital is the only government hospital with a developed palliative care department. “Our yearly requirement quota of medical morphine is close to six kilograms, and we have permission to distribute from multiple government agencies. But, there are challenges in supplying it, thanks to huge patient pool and lack of palliative departments in districts,” says R. Vineela, Project Co-ordinator, Department of Palliative Care, MNJ Cancer Hospital.

“The authorities are wary of morphine misuse, which is fair. A sustained attempt to popularise palliative care is needed,” feels Dr. T. Kannan, Director, MNJ Cancer Hospital.

Incidentally, there is lack of awareness among health care workers, policy makers, patients and even relatives about pain management. “Our medical curriculum does not instruct doctors on how to access and treat cancer patients with severe pain,” says Dr. P Raghuram, CEO and director, Ushalakshmi Centre for Breast Diseases. He adds that cancer control programmes at the national level do not have meaningful palliative care components, due to which palliative care has a second-tier status and does not receive enough grants. Those working in the field say that most corporate and government hospitals do not have medical morphine.

“It will not cost more than a rupee to manufacture and sell 10 mg of medical morphine. This is not a profitable business for pharmaceutical companies, and many shy away from manufacturing them,” experts say.

There are multiple uses of palliative care departments. “In addition to cancer, patients, due to other ailments like HIV, muscular dystrophy, dementia and heart problems, need pain relief. There is a need for exclusive palliative care wings at hospitals,” says Dr. Rohina R. Gupta of Pain Relief and Palliative Care Society.