Lack of morphine causing painful deaths in kids with cancer, lament oncologists

Children afflicted with different types of cancers have been dying extremely painful deaths at Karachi’s treatment facilities because morphine — the most potent drug for pain relief and symptomatic treatment of cancers — is often unavailable due to bureaucratic hurdles in acquiring medicines, leading paediatric oncologists told The News on Thursday.

“I’ve seen scores of children crying all day and all night due to extreme, excruciating pain because we often don’t have morphine to reduce their suffering after they’re diagnosed with cancer,” said Indus Hospital Karachi Executive Director Prof Dr Shamvil Ashraf.

“Morphine is the most important drug in the treatment of cancer patients, but unfortunately, it’s not easily available due to bureaucratic hurdles despite its local production.” The World Health Organisation (WHO) regards morphine as the first line of treatment for moderate to severe pain in terminal illnesses such as cancer, but every year, over 2.5 million children afflicted with different types of cancers die in need of morphine for pain relief.

Interviews with several oncologists in Karachi revealed that the unavailability of morphine and some other opioids, including fentanyl, was the most serious issue they were facing in treating cancer patients because it takes six to 10 months or even a year to get the drugs that are required on a daily basis to relieve extremely agonising pain.

“The pain faced by children with cancers is not only agonising for them but also for their parents and the healthcare staff treating them,” Dr Ashraf pointed out. “Whenever a child dies after suffering extreme agony because their pain could not be controlled due to the lack of a medicine that is available in the country, everybody gets depressed for weeks and months.”

Dr Asim Belgaumi, president of the Pakistan Society of Paediatric Oncology (PSPO), confirmed that hurdles in acquiring oral and injectable morphine is resulting in serious suffering for cancer patients, especially children.

He said children between the ages of one and 15 years are undergoing extreme agony on a daily basis because it requires months to get the medicines that could relieve their pain. “I can’t explain the plight of a 10-year-old child whose bone cancer has spread to his lungs. He feels like all the bones in his body have broken as he faces air hunger, desperation for getting oxygen — and all he needs is morphine, which is often unavailable.”

Dr Belgaumi said that there are dozens of medicines for treating cancers that are unavailable in the country. He claimed that the children with advanced stage of cancer they treated with morphine were even able to attend school a few weeks before death, saying that morphine improves the quality of life of cancer patients manifold.

When asked why it is so difficult to get morphine, he claimed that it is a common problem in developing countries, including India and Bangladesh, where thousands of children die painful deaths due to the unavailability of opioids, and lamented that the issue is never highlighted even by the media.

“From the PSPO’s platform we have raised this issue with the WHO and the local authorities, but there’s been no breakthrough. We need support of the media and society. The authorities should take this issue seriously,” he stressed, saying that seriousness is required to ensure end-of-life care of cancer patients in the country.

Pharmacist Arif Arain of the Indus Hospital Karachi said licence, permissions and no-objection certificates (NOCs) are required from provincial and federal authorities to get oral and injectable morphine.

He added that it takes six months to a year to get the allocated quota of medicine, while in this period, hundreds of cancer patients face painful deaths in front of their loved ones.

“The process to get morphine starts only after the hospital that has the licence exhausts all its available morphine. Now there’s no morphine at the hospital, and you have to wait for months before the provincial health and excise & taxation departments process your request, which is then sent to the federal narcotics ministry for an NOC.”

Drug Regulatory Authority of Pakistan officials pointed out that due to misuse of controlled substances, there are certain checks and balances in their provision, but clarified that the process to get these drugs is allowed to be initiated once 65 per cent of the stock of such drugs is exhausted.