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The struggle for pain relief in India


In less-developed countries, opioids such as morphine are generally not available for pain relief because of restrictive narcotics regulations imposed to prevent their misuse and diversion. M Rajagopal from the Pain and Palliative Care Society, India and colleagues from the USA describe in this week's issue of THE LANCET the work of a WHO Demonstration Project to improve the use of opioid analgesics for the treatment of pain in a large population of patients with terminal illnesses including cancer and HIV-AIDS.

The authors report how Indian government regulation of narcotics had to be simplified to ensure adequate and continuous availability of opioid drugs for medical use in pain relief and palliative care. They also present results of a study, which showed that there was no misuse or diversion (when a drug moves from a licit to an illicit channel of distribution or use) of oral morphine in a community-based program providing palliative care. In this study the distribution of morphine to 1723 patients was investigated in Calicut, India, who were being treated for pain on an outpatient home-care basis, with standard procedures for opioid accountability, recordkeeping, and prescription. Over 2 years, no instances of misuse or diversion were identified, clearly showing that oral morphine can be dispensed safely to patients for use at home in a less-developed setting. The project also showed how it was possible to overcome insurmountable regulatory barriers that had previously hindered the availability of morphine and its use in pain relief in India.

David Joranson comments: "Organisers of pain relief and palliative-care programmes can use this information to ask for cooperation from their governmental authorities, making them aware that opioids can be made safely available to patients with pain, as long as there are appropriate controls in place. If diversion should occur, the answer is to identify and address the reason, rather than limit the availability of essential drugs to patients."


Contact: Mr David Joranson, Director, University of Wisconsin Pain and Policy Studies Group, WHO Collaborating Center, 406 Science Drive, Suite 202, Madison, WI 53711-1068 USA; T) +1 608 263 7662; F) +1 608 263 0259; E)

Dr M R Rajagopal, Director, Pain and Palliative Care Society, A-5 Medical College Campus 673-008 Calicut, India; T) +91 495 356 531 ext. 258; F) +91 495 354 897; E)

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