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India has a problem with morphine Add to ...

Once again, Indian MPs have failed to help millions who need relief from pain.

In the winter session of Parliament that ended last month, they were expected to pass an amendment to an existing law that would allow people with cancer, AIDS or other serious diseases to receive morphine when they need it.

The current law, aimed at curbing drug abuse, makes it so difficult for hospitals to obtain morphine that cancer patients die in agony while their doctors and families look on helplessly.

MPs were so busy bickering about other issues they did not even have time to discuss the amendment. They should try touring rural India to see what happens when morphine is not available.

On a visit to my father recently at his home in a Punjab village, I asked about a neighbour’s daughter who had been hospitalized with breast cancer. “She died last month,” my father replied. “Everyone in the village used to hear her shrieking. The hospital said there was nothing they could do and sent her home.”

Most government hospitals, assuming they have such luxuries as oncologists, have no supplies of morphine. When patients are diagnosed with cancer and have no money to go to a private hospital (which can sometimes procure it), they walk out of the hospital gates to return to their villages or slums to die.

The reason is that the Narcotic Drugs and Substance Abuse Act of 1985, passed to prevent drug trafficking, lumps morphine in with other drugs as a narcotic (which of course it is) and imposes draconian restrictions on its manufacture and availability, even for medical use.

Owing to the law, drug companies don’t make it. Hospitals don’t stock it. So naturally, if it’s not available, doctors don’t prescribe it. To get their hands on morphine, hospitals have to apply for a special licence that can take five or six years. Once they receive it, they have to apply for several other licences to store it.

After protests by groups such as the Indian Association of Palliative Care, the government modified the law some years ago to allow India’s 28 states easier access to morphine, but only one third have acted on this provision. Why bother? The Indian elite’s indifference toward the poor is such that that no one has seen fit in more than two decades to amend the law. After all, it is the poor who are affected because the rich will always get morphine if they need it. If the amendment has come about at all, it is only thanks to the efforts of palliative-care advocates.

The paradox is that India is one of the world’s major producers of morphine, made from the flamboyant poppy. But 75 per cent of it is exported to the West. So while people suffering from serious diseases in North America and Europe receive morphine, Indians don’t.

Less than 1 per cent of India’s cancer and AIDS patients get morphine, unlike in developed countries, where it is easily available. In fact, morphine is a rich-poor issue not only within India, but among countries. Nearly 90 per cent of global consumption is in North America and Europe. Poor countries consume just 6 per cent. So it’s not only India’s poor who suffer. Across the world, the poor are deprived of morphine.

The amendment pending in India’s Parliament will relax the restrictions around morphine by simplifying the law. For example, hospitals will need just one licence rather than five, and a single agency will issue and monitor licences.

Unfortunately, MPs seem to feel no sense of urgency. Discussion of the amendment has now been postponed several times owing to other pending business.

But other business – coal regulation, taxes, insurance policies – can wait. This cannot.

Amrit Dhillon is a freelance journalist based in New Delhi.

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