Pubdate: Wed, 04 Mar 2015
Source: Los Angeles Times (CA)
Copyright: 2015 Los Angeles Times
Contact:  http://www.latimes.com/
Details: http://www.mapinc.org/media/248
Author: M.R. Rajagopal
Note: M.R. Rajagopal is founder and chairman of Pallium India, a 
palliative care nongovernmental organization based in Kerala, India.

A WAR AGAINST PAINKILLERS

In the United States , where doctors write more than 250 million 
prescriptions for painkillers a year, the frequency of abuse and 
overdose represents a public health crisis.

More than 15,000 Americans died from an overdose of prescription 
opioids in 2013.

In other parts of the world, however, the crisis is that strong 
painkillers such as morphine aren't available at all. More than 70% 
of the world's population live in countries with no access to 
opioids. That has been the case in India, where I am a palliative 
care physician.

Though the situation is slowly improving as result of reforms made in 
2014, most people in India can't get an opioid painkiller even when 
they're dying of cancer.

Like torture victims, these people say that their suffering is simply 
unbearable and that they would do anything to make it stop.

Consider this: A few years ago, Gopalan, a man with an ugly scar 
around his neck, came to see me. When I asked about the scar, he 
looked away in shame.

He had tried to hang himself to end the leg pain caused by a disease 
of his blood vessels.

His teenage children discovered him and saved his life.

Gopalan had, only at this desperate stage, been sent to my palliative 
care center by his hospital, which had no morphine or any doctor 
trained in its use. I could treat his pain here only because 
palliative care centers, unlike hospitals, have access to morphine. 
He got to spend his last few weeks with his family reasonably free of 
pain. In the end, however, he died not from his disease, but from 
kidney damage caused by the high doses of over-the-counter 
painkillers he had taken before.

Morphine costs pennies per dose, so why was it nearly impossible to 
get in most parts of India? This tragic situation has its origin in 
good intentions. As in many countries, drug dependence is a major 
social problem here. But fear of drug abuse can rob policymakers of 
their sense of reason.

In 1985, no doubt encouraged by America's own war on drugs, India's 
government put in place laws that dealt not only with illicit drugs, 
but also created new rules around pharmaceutical products containing opioids.

Those laws included a mandatory minimum 10-year prison term for any 
error with an opioid prescription - even a minor unintentional error 
that did not lead to any misuse.

It also required hospitals and pharmacies to maneuver through 
labyrinthine bureaucratic requirements each time they needed a new 
supply of these medicines.

The result was devastating: Within a few years, the medical use of 
morphine dropped 97%. It simply disappeared from our hospitals and 
pharmacies. A 2009 study by Human Rights Watch found that two-thirds 
of India's major public cancer hospitals did not stock morphine or 
other opioid analgesics, even though they attended to tens of 
thousands of patients with severe cancer pain.

Unfortunately, that devastating situation exists around the globe. 
The World Health Organization estimates that 80% of the world 
population lives in countries with limited or no access to opioid 
pain medicines, and that 5.5 million terminal cancer patients die 
each year without proper pain control.

As in India, it is generally not financial constraints that prevent 
people from receiving these medicines, but ill-conceived drug 
regulations or irrational fears surrounding their use.

In India we are starting to implement more rational controls, 
including a much simpler system for hospitals and pharmacies to 
obtain opioid analgesics. Still, we are keenly aware of the need to 
strike the right balance between our current situation and that in 
the United States. Your experience - the number of fatal prescription 
opioid overdoses tripled between 1999 and 2012 - stands as a warning 
for other countries.

With prescription pain medicines associated with so many tragedies, 
it is not surprising that news stories increasingly vilify them. But 
know that drug policy decisions in the U.S. are likely to have 
influence far beyond your borders.

Rational policies that reduce abuse without harming access to pain 
relief could set an example for the world's nations.

It is critical to remember that for many people, there is no life 
without these medications. Just ask Gopalan's children.
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MAP posted-by: Jay Bergstrom