With no morphine, 25 million die in pain each year

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More than 25.5 million people, including 2.5 million children, globally die every year with serious health suffering that requires palliative care.

"We estimate that the cost of meeting the global shortfall of about 48.5 metric tonnes of morphine-equivalent opioids is about US$145 million (122 million euros) per year if all countries had access to the lowest retail prices paid by some high-income countries", the team wrote.

The annual burden in days of severe physical and psychological suffering is huge - six billion days worldwide, 80 per cent in the low and middle-income countries, according to The Lancet Commission on Global Access to Palliative Care and Pain Relief, which studied this health issue for three years.

"This inequity in access to essential pain relief and palliative care is one of the world's most striking injustices, says The Lancet, in its latest report, 'Alleviating the access abyss in palliative care and pain relief - an imperative of universal health coverage".

Regrettably, 83 percent of the 61 million people undergoing severe pain live in low and middle income countries where access to low-cost pain relief tablets like morphine is a mirage. We have the right tools and knowledge and the cost of the solution is minimal.

"The fact that access to such an affordable, essential, and effective intervention is denied to most patients in low-income and middle-income countries and in particular to poor people.is a medical, public health, and moral failing and a travesty of justice", the authors of the paper write.

The Lancet Commission calls for an essential package of palliative care to be made available by health systems worldwide.

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The study says off-patent, inexpensive, oral morphine for pain relief costs as little as 3 cents per 10 mg. In the low-income nations, the same morphine cost 16 cents where and when it is available.

Not only was morphine harder to find in poor countries, it was also more expensive - at about 16 U.S. cents for 10 milligrammes compared to three cents in rich nations, the report said.

"The draconian Narcotic Drugs and Psychotropic Substances Act, which was a major hindrance to access to pain relief, was amended by Parliament in 2014". Additionally, they've developed a framework model for palliative care services that could help health care systems in countries with fewer resources deliver services to patients dying from painful diseases or living with chronic pain. "More than 90 percent of these child deaths are from avoidable causes".

The report was compiled by experts analysing the need for palliative care due to 20 life-threatening diseases such as HIV, cancer, heart disease, premature birth, tuberculosis, haemorrhagic fevers, lung and liver diseases, malnutrition, dementia, and trauma injuries.

For Julio Frenk, co-author and President of the University of Miami, the results are startling.

Out of the 172 countries studied, 25 nations provided had nearly no morphine and hence could not provide standard palliative care to their population with severe health-related suffering. A sixth of these people, who need palliative care, are in India. Another 15 countries distributed enough opioid analgesic to attend to less than one percent of those needing pain reliefs.

China has enough opioid analgesic to meet the needs of only 16 per cent of those needing pain relief; India four per cent; Indonesia 4.2 per cent; Pakistan 1.5 per cent; Nigeria 0.2 per cent; Bangladesh 3.9 per cent; Russian Federation eight per cent; and Mexico 36 per cent.

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