India: Opioid Availability - An Update
The World Health Organization (WHO) estimates that there are around 2.4 million people in India with cancer.1 Two-thirds of them, about 1.6 million, are likely to be in pain. Two-thirds of those in pain - at least one million - would need opioids belonging to step 3 of the WHO analgesic ladder. Morphine is the only available oral opioid from that step in India. If one person in pain needs an average of 100 mg of oral morphine a day, the annual quantity that would be needed for the one million people in pain from cancer alone would be 36,500 kg.
India grows poppy under license in the three Northern states of Uttar Pradesh, Madhya Pradesh, and Rajasthan (Fig. 1). Government of India (GOI) Opium and Alkaloid Factories extract opium from these poppies, then produce and export the raw materials used to manufacture opioid analgesics around the world. A tiny fraction of the raw material is converted to morphine for domestic medical use. Eventually that morphine reaches only a tiny portion of the needy. It is indeed paradoxical that two decades after ‘‘hospice’’ was introduced in India, people in pain in a major opiumexporting country have no access to it for medical use.
Previously we have referred to statistics reported by the GOI.2 We now question the validity of these reports and, more recently, the government has stopped reporting consumption statistics for morphine altogether, despite its obligations under the Single Convention on Narcotic Drugs (Rx). Consequently, there appear to be no reliable statistics for morphine consumption in India. No system exists to obtain consumption statistics from the states and to collate them at the national level. The one index of morphine consumption that we do have (though an indirect indicator of consumption) is the quantity of morphine salts sold from the GOI Opium and Alkaloid Factories (that form the only agencies performing this function) to companies that manufacture various formulations of morphine in India. During the five-year period between 2000 and 2004, the average annual quantity of morphine sold by these factories was 142.32 kg - a mere 0.4% of the possible need.