Medical Use, Misuse, and Diversion of Opioids in India
In less-developed countries, opioids such as morphine are often not available for pain relief because of excessive regulations imposed to prevent their misuse and diversion. We describe the effect that these draconian measures have had on the availability of drugs for medical use in Kerala, India, and present results of a study, which we did to ascertain whether or not the misuse and diversion of opioids is as prevalent as the government reaction would suggest. We followed 1723 patients in Calicut, India, who were being treated for pain with oral morphine on an outpatient home-care basis. Over 2 years, we did not identify any instances of misuse or diversion. These results suggest that, in the context of India as a less-developed country, oral morphine can be dispensed safely to patients for use at home. We recommend that palliative care programmes talk to concerned governmental authorities, to make them aware of the medical need for opioids, and communicate with local news media to increase awareness of palliative care and the use of these analgesics. Our project has overcome regulatory barriers that had interrupted availability of morphine and its use in pain relief in India.
The WHO estimates that 10 million new cases of cancer are diagnosed every year, with over 6 million people dying from the diease annually.1 According to projections, the annual incidence and mortality rates of cancer will double in the next 20 years, with over two-thirds of cases arising in less-developed countries1 where the disease is often diagnosed at an advanced stage.2
Although not inevitable, pain requiring relief is prevalent in people with cancer, particularly in those with advanced disease.3 Reports indicate that over 50% of cancer patients worldwide suffer unrelieved pain,4 which can destroy quality of life by making ordinary activities difficult or impossible. In late-stage cancer, pain management and palliative care should be the primary aim of treatment.3