India: Opioid Availability—An Update

Abstract

In India, a million people with cancer and an unknown number of people with other incurable and disabling diseases, need opioids for pain relief. Only about 0.4% of the population in need have access to them. Major barriers to access to opioids are complicated regulations and problems related to attitude and knowledge regarding pain relief and opioids among professionals and the public. The Pain and Policy Studies Group at Madison Wisconsin has been collaborating with many Indian palliative care workers and government officials to improve availability of opioids to those who need them for pain relief. As a result of this collaborative effort, the Government of India asked all state governments to modify the narcotic regulations following a model given to them. To facilitate the process, the collaboration has conducted workshops in 13 states in association with local champions. Currently, 13 states in India and one union territory have simplified regulations, but opioid availability has improved only in a minority of these states. Establishment of simple standard operating procedures to implement the simplified regulations, advocacy, and improved education of professionals are essential for further improvement of the situation. The past decade has demonstrated that government policy can be changed if palliative care enthusiasts work in tandem with the government. The progress has been slow, but real and encouraging.

Barriers to Effective Pain Management

“…Yet many countries continue to face barriers to delivering effective pain relief -not just of inadequate technology and facilities but in the inability to relieve pain through the fundamental use of opioids. A u s t r ia C a n a d a A u s t r a li a F r a n c e U K M a lt a S p a in I s r a e l I t a ly K a z a k h s t a n S in g a p o r e M o r o c c o E c u a d o r K e n y a A recent paper highlighted the numerous barriers India faced when importing opioids for the management of pain (Rajagopal & Joranson 2007). These included requirements for several licences to procure one consignment of morphine, inadequate health profession knowledge and interruptions to morphine supplies.…”

Palliative Care in Resource-poor Settings: Inequalities, Challenges, and Opportunities

“…After long and sustained efforts by palliative care enthusiasts, India has simplified narcotic regulations following lobbying educational interventions and awareness among all stakeholders, but opioid availability has improved only in a minority of the Indian states. 6 In our country, physicians focus more on opiates' side effects and opioid addiction, not their potential benefits, and pain control and palliative care are taught only in some medical schools. Other major barriers to access to opioids are regulations and problems related to attitude and knowledge regarding opioids among health professionals, policy makers and the public.…”

Ketamine: We need to continue to advocate against scheduling

“…Annual use of morphine in India dropped from 573 kg in 1985 (population of 782 million) to a mere 17 kg in 1997 (population of 997 million). 12,13 By comparison, my workplace, the IWK Health Centre for children and women, has fewer than 150 beds and purchased 0.2 kg of morphine in 2016. Even if these numbers compare a general population to a hospital-based population, the discrepancy in order of magnitude is astronomical.…”