Accessibility to morphine will improve further with the passing of The Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2011, said city doctors who have regularly faced hurdles when it comes to accessing morphine for patients suffering from terminal illnesses such as cancer, HIV and thalassemia.
Morphine is one of the cheapest and the best known pain-relieving drug. With the new act, which was passed by the Rajya Sabha on Friday, there will be a single window clearance to medical institutions wanting to store morphine.
“Earlier an institute required four to five licenses from different authorities to store morphine. Now only the drug controller will be the sole licensing authority and hence more institute would start storing the drug,” said Dr MR Rajagopal, founder and chairman, Pallium India adding that excluding Kerala less than 50 centres in the country store morphine. Kerala has about 146 centre which stock morphine.
Though the new act will increase accessibility training of doctors and nurses in prescribing morphine will be needed. “There are generations of doctors who have not dealt with morphine during their training period. Close to one million adults suffering from cancer require morphine in India and only 0.22% has access to it,” said Dr Nandini Vallath, consultant at the Trivandrum Institute of Palliative Sciences.
Doctors prescribe morphine to patients with severe to moderate pain. “More centres are required to store morphine, we have patients from interiors of the country suffering from excruciating pain who come to our hospital for getting these drugs,” said Dr RP Gehdoo, heading the pain clinic at Tata Memorial Hospital (TMH) in Parel which treats about 7000 patients annually. Dr Gehdoo recalled how patients who were unable to access morphine in a village in northern Indian had prepared a mixture from other such plants to relieve the pain.
CASE STUDY 1
Reay Road resident, Laxmi Gupta underwent a surgery after she was diagnosed of cervical cancer. Six months ago she complained of severe pain in her chest and back.
“We brought her to the hospital only to learn that her cancer has probably spread to her lungs. She cries in pain throughout the night and hasn’t slept properly for months,” said her daughter, Rita. After exhausting many advance pain medications, doctors at TMH started Gupta on morphine. “From the posture of the patients only the doctor can make out the patient’s pain. We have several patients who take oral tablets of morphine at home to ease their pain,” said Dr M Muckaden, head of palliative care at TMH.
Gupta whose lung fluids have been sent to the laboratory for detecting cancerous cells may require oral chemotherapy only if her body can take it. “As of now our concern is to reduce the pain and make her comfortable,” said her doctor. Out of ten patients that the clinic treats at least two to three may require morphine.
CASE STUDY 2
Since the last four years, Suman Chindarkar, 73, takes morphine tablets every day to relieve her from the unbearable pain owing to cancer. Chindarkar suffers from Chordoma, a rare type of cancer that occurs in the bones of the skull and spine. “She underwent two surgeries and radiation theraphy for her cancer but it relapsed. Doctors told us that a surgery would be risky and the only way is to reduce her pain,” said her daughter Rajlaxmi Pansare. “Initially she was put on a weak opioid drug but there was little comfort. In fact when we would talk to her, expressions on her face would change suddenly owing to the extreme pain.”
Doctors decided to put Chindarkar on morphine tablets which worked to ease her pain. “Though bed ridden she is comfortable, she watches television, reads books and has a good memory,” said Pansare. “But finding the morphine tablets is difficult. We have to buy the drugs on the day when the prescription is issued. If more hospitals start storing the drug, it will benefit many like me who spent days searching for the drug,” said Pansare.
Chindarkar’s doctor, Dr K Kothari, director of Pain Clinic of India said that patients and their relatives will be most relived from both the pain of cancer and finding the drug if the Act is implemented well.
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