Something as basic as pain management reaches too few, too late.
Almost 26 million people around the world die each year with serious suffering in part because of a huge gap in pain relief: The U.S. may be awash in opioid painkillers, but they're rare or unavailable in dozens of poor countries, says a new report.
The study was conducted by the Commission on Global Access to Palliative Care and Pain Relief, which included 61 authors from 25 countries, including Pallium India chairman Dr. M. R. Rajagopal.
"More than 80% of people needing palliative care live in low- and middle-income countries". She co-chaired a Lancet-appointed worldwide commission that spent three years studying the disparity and what she calls "the moral obligation" to help. About 25.5 million adults and 2.5 million children are among those who die without adequate relief. They analysed 20 life-threatening and life-limiting health conditions (including HIV, cancers, heart disease, injuries and dementia) and 15 corresponding symptoms (including pain, fatigue, wounds, anxiety and depression) that were most frequently associated with the need for palliative care and pain relief.
In Kerala, which has 170 institutions providing palliative care, a palliative care policy was introduced in 2008, Dr Rajagopal said. Closing the pain gap would cost $145 million. Today each gram panchayat has a palliative care nurse providing home visits to every bed-bound patient once a month.
Addressing morphine access is even less costly. "Efforts to prevent non-medical use of internationally controlled substances, such as morphine and other opioid analgesics, have overshadowed and crippled access to opioids 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.
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. But of the 298.5 metric tons of morphine distributed worldwide, only 10.8 metric tons (3.6 percent) end up in health care systems of low- and middle-income countries.