Patients suffering chronic pain are being denied treatment in low-income countries because of restrictive laws.
There is a huge unmet need for pain-relief drugs in poorer countries and laws need to be relaxed to make it easier to get them.
Despite being home to close to 80% of the world's population, low- and middle-income countries consume less than a third of the world's morphine for medical purposes. The imbalance in usage hasn't changed in two decades.
The US received more than 3000% of the required amount of morphine for each patient, while Haiti received less than 5%, according to a study.
Dr MR Rajagopal said that he sees people who have been on disease specific treatment go through pain and suffering for weeks, months or years. Almost all of them in my country are denied pain relief at some point. Several people with scars around their neck have tried to hang themselves.
Rajagopal said that doctors were often scared to prescribe pain-relief drugs to patients because they didn't want to offend their religious beliefs.
He said that the control of opioids was one of the factors that led to the growth of the laws. Hospitals and pharmacies stopped stocking opioids because of the global "war on drugs". He said that India's use of Opioids dropped from a yearly average of 600 grams in 1985 to 17 grams in 1997.
The human toll of NCDs is growing. More than 40 million of the 56 million people who die each year are in the developing world. You can't catch NCDs like a virus. They are caused by a number of factors. Cancers, chronic respiratory illnesses, Diabetes and cardiovascular disease are the main types. Around 80% of the world's population is preventable, and all are on the rise as older populations and lifestyles push being healthy a global phenomenon. The poor now have a hold on NCDs, which used to be seen as illnesses of the wealthy. Being poor makes it less likely that you will be diagnosed with disease or death. The cost to families, economies and communities is staggeringly high when it comes to tackling common and chronic conditions. NCDs are seeing a fraction of the money needed being invested or donated in low income countries. Cancer death rates have gone past the death toll from Malaria, Tuberculosis and HIV/Aids in recent years. The Guardian is reporting on NCDs in the developing world in a new series called "A common condition". Tracy McVeigh is an Editor.Quick GuideShow
He said that advocacy efforts had helped relax regulations in some parts of India, but that still only 350 kilograms of the drug were being consumed annually.
According to Gary Rodin, the director of the Toronto-based Global Institute of Psychosocial, Palliative and End-of- Life Care, there has been an increase in the number of diseases in low- and middle-income countries.
It would have been a big part of medicine in the past. People pay more attention to Cat scans and other scans than they do to the suffering of the patient as medicine has gotten more technologically advanced. He said that they haven't asked enough about the suffering.
Rodin said that it has resulted in more aggressive treatment even when it isn't likely to work.
In advanced disease, suicide rates are very high. Family and psychological distress are both very common. We don't do enough to support many of the approaches we have evidence for.
According to Rodin, relaxing laws and training healthcare workers to administer painkillers can help ease the suffering of dying patients.
Julia said that neglecting a patient's pain can have a significant impact on their quality of life.
If they can't work, the family will become poorer and the children won't be able to attend school. She said that the impact of having pain that is not controlled goes beyond the individual.
The US's opiate crisis has made doctors fear that patients who are prescribed them will become addicted. He said that addiction in the US was related to the marketing of narcotics.
There is pain that is not visible. It is not visible to the world when it happens in a hospital bed. The US epidemic and overdose deaths are quoted in the headlines. No one talks about the success of western Europe over the last 50 years. Rajagopal said that the work becomes harder when we try to have talks.
There has been progress in Uganda, India, and Kenya but more needs to be done to train medical staff.
Some progress has been made in relaxing the country's opiate laws.
A patient came to me with so much pain that he just wanted to die. I started him with a lot of pain management and steroids. He grabbed me in the hospital and said thank you. Ali said that he didn't want to die anymore. We don't cure the disease, but it can make you feel better.
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