December 2001
Dear Readers: Here's the Article for this Month:
Name of article:
Medical use, misuse, and diversion of opioids in India
Author(s): MR Rajagopal, David E Joranson, Aaron M Gilson
Reference: The Lancet 2001; 358: 139-43
Abstract:
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 a
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.
Why I chose this Article:
This lovely article was chosen to demonstrate how difficult it is yet in the year 2001 to administrate an adequate therapy with oral morphine and other opioids to manage cancer-related pain, because of regulatory barriers imposed to prevent opioid misuse and diversion.
Although the study carried out by the authors did not identify any instance of misuse or diversion, the physicians and nurses involved in palliative care daily battle with all the difficulties they come up against in order to adequately treat all their patients with cancer-related pain. These physicians and nurses put in time, energy and financial resources for such care in view of the excessively strict narcotic regulations. All our support and admiration reaches out to them.
Regards,
Carla Ripamonti, MD
Member of the Board of Directors, IAHPC
