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Palliative Care

Ensure access to morphine to give relief to patients: Experts

Mahbuba Zannat
Parveen, a 42 year-old woman of Lalbagh in the city, cannot sleep at nigh t because of severe pain.
She has been diagnosed with squamous cell carcinoma and her left cheek has been almost eroded in just eight months.
Apart from her physical anguish, the mental torment of knowing that most of the medical community have washed their collective hands off her weighs constantly on her mind
But for now she is in excruciating pain.
The medicine that is needed most for her is morphine, the gold standard drug for pain relief and cancer. But the tragedy is that we are yet to make this effective drug available for the patients who need it badly." said l*roject Coordinator of the Palliative Care Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) Dr Nezam Uddin Ahmad.
'Here we are helpless and tired of seeing how the patients are suffering from pain looking for morphine desperately and coming back in an empty hand.-' said Dr Rumana Dowla, honorary pain and palliative care physician at the National Cancer Research Institute and Hospital (NCRIH).
“Wfe have found that more than 50 percent of cancer patients coming in the Pain Qinic of NCRIH have been suffering from severe pain,* sheadded.
A survey report of NCRIH in 2005 revealed that most of the cancer patients are of low income group
and more than B0 percent patients were earning less than I k 5000 per month.
The oral morphine is comparatively cheaper and the poor people can afford it.
“But even the hospitals specialised for cancer has no supply of morphine and so we are forced to use alternative drugs which do not always work effectively," said Prof Parveen Shahida Akhtar of the Department of Medical Oncology at NCRIH and in-charge of Pain and Palliative Clinic tliat has been running from November 2006.
Side effect of morphine is ver)' little and we use it when the alterna live drugs fail,” she added.
Being a narcotic, manufacturing and marketing of this drug is restricted and that is why Gonoshasthya Pharmaceuticals and Essential Drug Company Limited have been producing this drug in a limited amount But it cannot be marketed properly as very few drug stores have licence to sell moqihine.
As a result, the patients in one hand are suffering awfully as they are not getting this drug from the drug stores and on the other hand a huge amount of morphine manufactured by Gonoshasthya Pharmaceuticals remains unsold.
“As an insignificant number of drug stores have licence to sell narcotic drugs, often we face problem to market these drugs that ultimately make the patients suffer," said Executive Director of Gonoshasthya Kendra Dr Zafrullah Chowdhury, adding that many big
manufacturers do not show interest in producing morphine to avoid the harassment that has to bear to get permission in importing raw materials and manufacturing as well as marketing the drug.
"But the cancer pain is a serious public health problem and is prevalent throughout the world Only the patients, close family members and the health workers concerned probably know how precious the morphine is to give reliel from severe pain. Unrelieved pain destroys a person's quality of life and is one of the driving forces behind growing interest in even physician-assisted suicide and euthanasia in some parts of the world," said Dr Nezam Uddin.
The Department of Narcotics Control has imposed restrictions in manufacturing, marketing and using the drug saying it could create addiction and people might abuse the drug.
But according to the experts the reality is that morphine is not addictive for cancer patients with severe pain, rather it is one of the most effective drug to relive their pain without much sideeffect.
The inadequate availability of morphine continues to be a problem in many parts of the world particularly in countries like Bangladesh, they added.
"National anti-drug campaigns tend to ignore the medical benefits of opioids. The increasing abuse of drugs and clandestine conversion of morphine into heroine have made many governments wary about the supply of morphine to hospitals and
hospices," said the experts.
But die international drug trea ties not only recognise the dangers associated with the abuse of and trafficking in narcotic drugs, but also recognise that they are indispensable for the relief of pain and sufferings, they added
A special report of the International Narcotic Control Board of the United Nations on the availability of opiates for medical needs emphasised that every government has a dual drug control obligation to ensure adequate availability of narcotic drugs, including opiates for medical and scientific purposes, while at the same time preventing the illicit production and trafficking in the use of such drugs.
In the same report, the board stated that there was evidence suggesting the medical needs of opiates, particularly for the treatment of cancer pain.
Even the Delhi High Court in response to a writ in 1998 directed the government to speedily attend the requests for morphine for legitimate use.
The use of morphine has increased in developed countries like Germany, Japan, the UK, the USA and France, whereas in developing countries only very small amount of morphine is used.
Countries like Bangladesh where many cancer patients die without treatment, and many are incurable when they enter the hospital, pain management and palliative care are the most human responses in such situations, the experts added.