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Al Jazeera Global 16×9 CBS Sunday Morning Al Jazeera English’s “People and Power” featured a half hour documentary on the IRP’s Pain Project Canadian broadcaster Global’s magazine program “16×9” featured a two-part series on the IRP’s Pain Project CBS Sunday Morning features the Pain Project’s reporting on the Uganda solution to morphine access Freedom From […]

  • Al Jazeera English’s “People and Power” featured a half hour documentary on the IRP’s Pain Project
  • Canadian broadcaster Global’s magazine program “16×9” featured a two-part series on the IRP’s Pain Project
  • CBS Sunday Morning features the Pain Project’s reporting on the Uganda solution to morphine access
A map of morphine access
around the world
Imagine recovering from major surgery or suffering from advanced cancer without any painkillers. That’s the reality for patients in half the countries in the world. But unlike with so many global health problems, this one is not about money or a lack of drugs. Morphine, the gold standard for medical pain treatment, is simple and cheap to make and distribute. So why are so many people left in pain?

The International Reporting Program traveled to Ukraine, Uganda and India to find out, and to document the human toll of this hidden human rights crisis. It turns out a combination of bureaucratic hurdles and the chilling effect of the global war on drugs are largely to blame, leaving humanitarians scrambling to work outside the law — or change the law — to bring relief to millions of suffering patients.

In India, we met patients like Fatima, who screams day and night because her breast has been eaten away by a festering tumor. Doctors do what they can, but opiates like morphine are largely off limits because of draconian drug laws in that country.

In Ukraine, we met a former KGB colonel who is dying of prostate cancer and sleeps with a gun under his pillow in case the pain gets unbearable. The county’s Soviet-style bureaucracy won’t allow him to get more than the allotted 50 mg of morphine a day, far too little to ease his suffering. We follow a brave young man as he comes to the rescue, risking serious prison time, by smuggling narcotics to the colonel to supplement his dose.

We visited Uganda, a country that has found creative solutions to getting morphine to even the poorest and most remote patients in the country. By making access to pain treatment a basic human right, and by changing drug prescription laws, this small African country has set the model for how other nations could address the unavailability of morphine.

Finally, we went to the United Nations to challenge diplomats on the blunt drug laws that curtail access to legitimate medical opiates, and the executive director of the UN Office of Drug Crimes admits that a side effect of his work is that patients around the world suffer unnecessarily.

This website provides a global overview of pain relief access, with a central video documentary, a map that shows the scope of the problem, and additional material about the history and science behind pain and pain treatment.

India

India is one of the world’s largest producers and exporters of opium, and its citizens have consumed the drug for both cultural and religious reasons for centuries. But in 1985, in response to pressure from the UN, the country passed the Narcotics and Psychotropic Substances Act, which had the unintended consequence of rendering access to morphine — a derivative of opium and the gold standard for pain treatment — virtually impossible.

Thirteen years later, India’s central government asked its states to loosen their regulations. However just 13 of 28 states complied, and access to the drug remains scattered at best.

One notable exception is the state of Kerala, where the government changed its laws to ensure that terminally ill patients get the morphine they need. And until his state follows Kerala’s lead, Dr. Abhijit Dam has come up with a formulation of his own to help ease patients’ pain.

Uganda

Despite limited medical resources, the small, war-torn country of Uganda stands as a model for palliative care in Africa. In 2000, it became the first country in the world to declare palliative care an essential service for its citizens. And since 2004, it has allowed nurses to prescribe and administer morphine to patients in their homes.

Uganda’s success in treating patients would not have been possible without Dr. Anne Merriman. Internationally recognized for her work in palliative care, Merriman in the early 1990s was invited to Uganda to help establish a hospice program. She made liquid morphine an integral part of the program’s approach to pain management. Hospice Africa Uganda also trains nurses on how to administer the drug, and has so far helped them ease the suffering of more than 18,000 patients.

Ukraine

In Ukraine, terminally ill people living at home are limited to receiving just 50 milligrams of morphine per day, a fraction of the allowable dose in Western countries. Worse, the drug is only available through injection, and must be administered by a visiting nurse or doctor — a painful and often inconsistent process. The result is that many Ukrainians spend their final days needlessly suffering.

Sluggish bureaucracy and lingering fears of drug addiction have prevented Ukraine from loosening the restrictions on morphine for pain management. And a long-held belief in the nobility of suffering has helped keep the country’s approach intact.

With little relief in sight, at least one courageous man has decided to deliver morphine to such patients themselves. The way he sees it, the benefits of his actions far outweigh the risks involved.

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Copyright © 2011 University of British Columbia Graduate School of Journalism. All rights reserved.
Generous support provided by the Mindset Social Innovation Foundation and the MITACS Accelerate Project.