Study puts a count to suffering people in need of palliative care

No access to morphine leads to the agonizing deaths of 26 million people a year, report says | Miami Herald

More than 80 percent of these cases are in low- and middle-income countries.

Something as basic as pain management reaches too few, too late.

Poor people around the world live and die with little or no pain relief or palliative care, a report published today in the medical journal, Lancet, said, calling the fact a "medical, public health, and moral failing and a travesty of justice".

The report, prepared by global health and palliative care experts, of which I, in my capacity as Human Rights Watch's health director, was one, found that more than 61 million people worldwide experienced severe pain, fatigue, nausea, vomiting, and other symptoms common to illnesses like advanced cancer, diabetes, and heart disease.

Some 2.5 million children are among the annual count of almost 26 million who die without adequate relief, the team calculated.

Nearly 80% of deaths requiring palliative care in low-income countries are preventable with adequate prevention, treatment and care interventions, said Professor Felicia Knaul, co-chair of the Commission from the University of Miami, in a statement. It said inequity in access to essential pain relief and palliative care was one of the world's most striking injustices. The study said that though off-patent cheap immediate-release morphine for pain relief costs as little as three cents per 10 mg and is an essential component of palliative care, less than one per cent of the world's supply went to low-income countries where the need was the greatest.

"Though the Government of India announced a national programme for palliative care in 2012, the budget allocation has been grossly inadequate and progress in the last five years negligible", said Pallium India chairman Dr M R Rajagopal. Closing the pain gap would cost $145 million.

"Oral morphine in palliative care in most countries is nonexistent".

In numerous countries, oral morphine isn't available, even though it's affordable. In Afghanistan, India and Nigeria, for example, less than 5 percent of pain management needs are met, according to the report.

The Lancet panel looked to lessons from the USA opioid crisis, and from Western Europe, which has avoided similar abuse thanks to strict opioid monitoring and to universal health coverage for non-opioid treatments for chronic pain, said report co-author Dr. Lukas Radbruch, a palliative care specialist at Germany's University of Bonn. Of the 298.5 tonnes opioids in morphine distributed worldwide, 10.8 tonnes (3.6%) is distributed in low- and middle-income countries, with 0.1 tonne (0.03%) in low-income countries.

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