Denying Pain Medication: An International Law Violation?

It wasn't an ad you'd expect to see in the classified section, but there it was, nonetheless: Cancer is killing us. Pain is killing me because for several days I have been unable to find injectable morphine in any place. Please Mr. Secretary of Health, do not make us suffer any more.

That was the entreaty made in September 2008 in a Colombian newspaper -- one that reflects the fact that around the world, literally tens of millions of people are dying in unnecessary pain, the result of limited access to pain medication. And according to a new report by Human Rights Watch, lack of access to treatment for severe pain isn't just a government failure, it's a crime -- one that violates an international prohibition on cruel, inhuman and degrading treatment.

Unlike many health issues we write about, pain medication shouldn't be a complicated one. As HRW writes, it's "cheap, safe, effective and generally straightforward to administer." In 1961, a global agreement acknowledged that narcotic drugs are "indispensable for the relief of pain and suffering," and countries committed to providing them to their citizens.

That was 50 years ago. So what went wrong?

There are literally dozens of reasons that account for continued barriers to access: weak morphine supply and distribution systems, nonexistent palliative care guidelines for practitioners, et cetera. And then there's another factor that we've frequently blogged about here: an over-zealous stance on drugs, one that's cut thousands of cancer patients off from access to morphine. As a result of all these forces, nearly 80% of the world -- cancer and HIV/AIDS patients, among others -- are denied relief from their pain.

Of course, there are basic pain relievers out there that don't face as many strictures: aspirin, for example, or for moderate pain, weak opioids like codeine. But stronger pain -- such as that which afflicts cancer patients -- requires morphine, a drug that the World Health Organization calls "absolutely necessary" to managing pain. It's cheap (can be produced for as low as $0.01 per milligram), and when taken in basic oral form, not protected by any patent. And yet concerns over addiction, ignorance, lack of training and fear of drug diversion all conspire to keep the drug out of needy patients' hands.

That's true in the U.S. and Europe as well, where a Feb. Annals of Oncology study found that fear of drug abuse and too-stringent regulations on opioid-based drugs like morphine means that cancer patients are "suffering unnecessarily."

Something in this calculus is clearly askew. Meanwhile as Lindsay Beyerstein notes, on the same day that HRW's report was released, Afghanistan announced yet another "doomed attempt to eradicate opium poppies." Would saving those crops manage to put pain medication in the hands of the tens of millions who currently lack it? Obviously, it's not as simple as that. But still, it's a brittle irony that as people with cancer and HIV/AIDS around the world wait, their best chance at pain relief is literally being eradicated.

Photo Credit: isafmedia