Many of you who know me in “real” life know I am passionate about extending access to essential medicines to patients around the world, especially in developing countries. I am still haunted by memories of hearing people at the steps of my home country’s Cancer Institute beg for money for chemotherapy drugs, which they had to pay for out-of-pocket. Living with cancer is enough of a heartbreaking ordeal, but not being able to afford the necessary treatments adds insult to injury. My mother and sister (who both worked at the Institute) tried to shield me from these sights, but I am glad they weren’t successful, because this was a formative experience, and inspired a big part of my volunteer work during my undergrad career.
The reasons underlying a lack of access to essential medicines are many and complex – some are financial, often a result of high prices set by pharmaceutical companies; but even off-patent, generically produced drugs can be out of the reach of many patients in need, for reasons relating to transport infrastructure, difficulty accessing health care facilities, and a lack of health care workers trained to prescribe and dispense these drugs.
Sometimes, however, all the aforementioned factors are in place, and the reasons for denying access to life-enhancing medications to patients who desperately need them are purely bureocratic. Such is the case with medical morphine, which costs pennies to produce, and is the painkiller of choice for people suffering from terminal illnesses such as cancer and AIDS. Morphine for medicinal use has been an innocent bystander caught in the crossfire of the global war on drugs, because its misuse can lead to opiate addiction, and because it can be used to manufacture heroin.
The fear of abuse and diversion to the illicit drug market has prompted many developing countries to adopt excessively strict laws governing the medical use of morphine. This makes them near-impossible to access even by patients suffering from severe, long-term, chronic pain. As eloquently stated by Kimberly Green, a palliative-care expert in a health development organization in Vietnam, “Something is wrong when it’s easier to buy heroin than it is to buy morphine”. In 2003, developing countries, representing 80% of the world’s population, accounted for just 6% of the total morphine consumption. Access in the developed world is considerably better.
I recently watched Freedom from Pain, a 25-minute documentary on the under-reported lack of access to pain medicine crisis. It’s an eye-opener. I urge you to at least read the synopsis, which provides excellent examples of how the medical/legal systems of developing countries handle the medical use of opiates like morphine, the key barriers imposed on access, as well as stories of places where those barriers have been surmounted.
Success stories like that of Uganda (the first country in Africa to state, in words and practice, that palliative care is an essential service for all citizens), give me hope that one day I will live in a world where access to pain treatment is considered a basic human right in all countries, where the rational use of pain medications is practiced everywhere, and where the nebulous threat of fuelling the illicit drug market does not leave millions of patients suffering in agony. Until then, there is a long road to go.
For further reading:
Morphine Remains Scarce for Pain Sufferers Worldwide (Time, 2010)
Medicines: Access to Controlled Substances (World Health Organization, 2010)
Global State of Pain Treatment (Human Rights Watch, 2011)