Pain is a very common symptom in people with illnesses like cancer and HIV/AIDS. When not treated, it can severely undermine the quality of life of both the patient and their family. The World Health Organization (WHO) considers morphine an essential medicine for pain and palliative care and recommends it be available to anyone who has a medical need no matter where they live.
Yet, the report, prepared by the International Narcotics Control Board (INCB), notes that about 92 percent of morphine used worldwide is consumed by only 17 percent of the world population, primarily living in the United States, Canada, Western Europe, Australia, and New Zealand. That leaves precious little for the rest.
Ironically, the 83 percent who live in low and middle-income countries actually have a proportionally greater need for these medicines because that’s where the majority of cases of advanced cancer and HIV/AIDS occur.
While resources obviously have some role to play, there is another key reason for this huge inequality in access to pain medicines: in the heydays of the “war on drugs,” many countries put in place draconian laws that severely restricted the use of morphine. India’s drug act, for example, required hospitals to get four or five different licenses from different government agencies to obtain morphine and mandated mandatory jail terms even for unintentional clerical errors in handling the medication. The unsurprising result: most hospitals stopped stocking it.
Or consider Ukraine’s regulations: they required that morphine be administered to patients directly by healthcare workers, making the medication practically inaccessible for most patients dying at home.
In the past five years, recognition is dawning that the war on drugs has turned millions of cancer patients into collateral damage: Nobody intended to deprive access to pain medicines, but that’s what happened.
Slowly but surely governments are starting to address this public health crisis. In 2013, Ukraine changed its regulations and now allows patients to take home a 15-day supply of morphine. In 2014, India amended its law, setting up a simple one-license system for obtaining morphine.
It’s encouraging to see the INCB highlight this issue so prominently in its annual report. Let’s hope it prompts a lot more discussion, if not action, on the part of the many countries still lagging behind on this important issue. We owe it to the 5.5 billion still at risk.
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Diederik Lohman is an associate director with the Health and Human Rights Division at Human Rights Watch, where his work focuses on access to palliative care, including controlled medicines for the treatment of pain and international drug control policy. Previously, he served as senior researcher in Human Rights Watch's Europe and Central Asia division and as the Moscow office director. Lohman has conducted extensive research on, and written about, drug dependence treatment and HIV treatment for drug users, human rights in armed conflict and inside the armed forces, and police abuse. He founded the Russian Justice Initiative (previously Chechnya Justice Initiative), an organization that helps victims of the conflict in Chechnya seek justice through domestic institutions in Russia and the European Court of Human Rights. Lohman has a background in Russian studies and international law and speaks Russian, Dutch, and German.