Universally Coping With Pain

"While clearly there are issues with some prescribing practices, there's also clearly a risk to vilifying these medicines [opioid painkillers]."
"[In some countries] a clerical error in a morphine prescription [can lead to criminal inquiries]."
Diederik Lohman, Human Rights Watch

"Many low-income and middle-income countries continue to fail to provide adequate opioid analgesic medicine for pain."
Report: International Narcotics Control Board, United Nations

"It's not that we shouldn't be concerned about addiction."
"We basically have zero access in most countries around the world. You don't go from zero to the situation in the United States [addictive risks with the use of pain-relief drugs too freely available]."
Felicia M. Knaul, international health economist

Chris Hondros  /  Getty Images file  

In the United States, the abuse of prescription medications has gone beyond almost all illicit drugs with the exception of marijuana, according to the International Narcotics Control Board 

 

In North America, a runaway problem of prescription drugs readily available on the street has led to widespread drug addiction and the use of opioids and more powerful drugs like fentanyl causing an epidemic of drug overdoses and death. The abuse of prescription-type drugs which have a societal value in helping seriously ill people cope with pain, has arisen as a public health-addiction issue in Canada and the United States, but elsewhere in the world there is a clear shortage both of painkillers and the institutional-political willingness to make them available to health sufferers.

Extremely sick people whose legitimate requirement for drugs to ease their intolerable pain find oxycodone and other narcotics out of their reach and the result is inevitably that they suffer and they die in pain. This, according to health officials, doctors' and patients' rights advocates. Many doctors in Russia, India and Mexico, fearful of possible prosecution or other problems with legal authorities feel reluctant to prescribe painkillers.

Only recently have health officials in Kenya authorized production of morphine, as one of the most effective of pain-relief drugs, to make it available to those in dire need of pain relief. It had been available only in a handful of the country's 250 public hospitals, leading to a public outcry and criticism that authorities had little option but to heed. The Human Rights Watch advocacy group reported that only a small fraction of doctors in Morocco are allowed to prescribe opioid analgesics since they're considered poisons in that country.

Even for patients suffering from the dreadful effects of terminal cancer, AIDS or wounds suffered from conflicts are unable to access painkillers since in most poor- and middle-income countries such drugs are restricted and largely unavailable. An absence of medical training, onerous regulations, prohibitive costs and an official drive to eliminate the scourge of illicit drug use, along with a cultural acceptance of pain have all led to this situation.

A report issued from the International Narcotics Control Board indicated that the use of opioid analgesics had grown exponentially in North America, Central and Western Europe and Oceania, but remained in low usage in Africa, Asia, Central America, the Caribbean, South America and Eastern and Southern Europe. According to Stefano Berterame, heading the narcotic control and estimates section of the board, officials in many of those countries cite expense and a lack of suppliers.

The World Health Organization estimates that 5.5-billion people in countries with "low or nonexistent access to controlled medicines for the treatment of moderate to severe pain", are out of luck when it comes to access to painkillers. In other words, it is being recognized as a human right for people to be able to have their pain humanely alleviated with the prescribed use of opioids, but due to a multitude of reasons, economic and cultural, legal and accessible, they are denied that relief.

In Mexico for example, an amendment in its health law requiring hospitals to offer palliative care to terminally ill people, which was passed in 2009, was ignored for years. Leading to a situation where, as Human Rights Watch pointed out, "tens of thousands" of Mexican patients were unable to access the pain relief they were entitled to. "The irony for a pediatric oncologist is that it's much easier to buy [drugs] on the street than go to a hospital [to obtain painkillers]" observed Ms. Knaul.