Health Care

Millions die suffering amid global opioid gap, report says

Millions die suffering amid global opioid gap, report says”

More than 25.5 million people, including 2.5 million children, globally die every year with serious health suffering that requires palliative care.

The study, commissioned by The Lancet, was conducted by the Commission on Global Access to Palliative Care and Pain Relief.

M.R. Rajagopal, one of the five lead authors of The Lancet study and the chairman of Pallium India, said despite announcing a national programme for palliative care in 2012, India had made negligible progress in providing palliative care in the past five years. More than 80% of these cases are in low- and middle-income countries, where access to immediate release morphine, an essential and cheap medicine to alleviate pain, as well any other type of palliative care, is severely lacking.

Of this total, some 83 percent live in low and middle-income countries where access to low-cost, off-patent morphine is rare or completely unavailable, even though the cost should be pennies a tablet. This global pain crisis has relief too! We have the right tools and knowledge and the cost of the solution is minimal.

"We can not allow opiophobia to keep affordable, essential medicines from low-income patients in agony as they fight diseases such as cancer, HIV or near end of life".

Created to be low-priced and covering medicines, basic equipment and human resources, one of the minimum requirements is the availability of oral or injectable morphine. In high-income countries, a pain-relieving dose costs three cents per 10 mg. In low-income nations, the same morphine cost 16 cents where and when it is available.

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"The biggest shame is children in low-income countries dying in pain which could be eliminated for $1 million a year", she said.

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.

The global health community has largely ignored this, the report said. Commenting on the report, Jim Yong Kim, president of the World Bank, says: "Failure of health systems in poor countries is a major reason that patients need palliative care in the first place". "More than 90 percent of these child deaths are from avoidable causes".

They have called for more balanced global policies to facilitate access to opioid analgesics to meet medical need, while limiting non-medical use. "The enormous disparity between need and availability of opioids for palliative care is growing and skewed against people living in poverty", Frenk said.

Not only was morphine harder to find in poor countries, it was also more expensive - at about 16 USA cents for 10 milligrammes compared to three cents in rich nations, the report said. Of the 172 countries studied, 25 had essentially no morphine, while a further 15 had enough to meet less than one percent of pain relief requirements. India - among eight of the largest global populations - was meeting the needs of just four percent of those requiring pain relief, The Lancet medical journal reported warning of a "global pain crisis".

The report was compiled by experts analysing the need for palliative care due to 20 life-threatening diseases such as HIV, cancer, heart disease, premature birth, tuberculosis, haemorrhagic fevers, lung and liver diseases, malnutrition, dementia, and trauma injuries.



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