One specialist who has long warned that the USA addiction crisis could spread internationally said the proposal for poor countries to avoid patented opioids was a "sensible" approach.
"At least 35.5 million people who did not die also experienced serious health-related suffering [in 2015], meaning that the total number of people needing palliative care per year was over 61 million, including 5.3 million children", Dr M R Rajagopal, co-author of the Lancet study on Global Access to Palliative Care and Pain Relief told The Indian Express. The limited supply of these drugs in some nations means millions of people throughout the world are faced with chronic unnecessary pain and spend their final days of life in agony. A new report published online in The Lancet Thursday says that worldwide, more than 25.5 million people a year (almost half of all deaths in 2015), including 2.5 million children, die with serious physical and psychological suffering as a result of disease, injury or illness. More than 80 percent of these cases are in low- and middle-income countries.
The study highlights inequities in access to morphine for palliative care.
The world's poorest countries have access to enough morphine to meet less than 2 percent of their palliative care needs, the report found. India fares little better, at 4 percent; China meets 16 percent of its need, and Mexico 36 percent. Of the 298.5 tonnes opioids in morphine distributed worldwide, 10.8 tonnes (3.6%) is distributed in low- and middle-income countries, with 0.1 tonne (0.03%) in low-income countries. The study said that though off-patent cheap immediate-release morphine for pain relief costs as little as three cents per 10 mg and is an essential component of palliative care, less than one per cent of the world's supply went to low-income countries where the need was the greatest.
The Lancet panel looked to lessons from the USA opioid crisis, and from Western Europe, which has avoided similar abuse thanks to strict opioid monitoring and to universal health coverage for non-opioid treatments for chronic pain, said report co-author Dr. Lukas Radbruch, a palliative care specialist at Germany's University of Bonn.
"The fact that access to such an affordable, essential, and effective intervention is denied to most patients in low-income and middle-income countries and in particular to poor people.is a medical, public health, and moral failing and a travesty of justice", the authors of the paper write.
-Countries should use cheap, immediate-release oral and injectable morphine for severe pain.