Addiction fears deny cancer patients access to pain drugs

A nurse at Kiirua Mission Hospital attends to a cancer patient. photo | PHOEBE OKALL

What you need to know:

  • Experts want law change to allow more practitioners to dispense crucial medicine such as morphine.
  • A 2016 study published in The Lancet journal revealed that whereas use of opioid drugs like morphine had grown in the developed world, their use in Africa and other developing nations was still low.

David Kinyanjui lost his mother to breast cancer a decade ago. Even though the disease had been diagnosed at an advanced stage, the family was keen on helping her cope with the symptoms effectively.

“But that didn’t happen. She suffered constantly from unbearable pain and the pain killers they gave her didn’t seem to work.

“Mum eventually succumbed to the illness. And even though we were sad to see her go, we were happy that death had taken her to a peaceful place free of the pain.”

Many patients suffering from adverse effects of cancer as well as other chronic illnesses are usually weighed down by pain, which compromises their quality of life.

Yet experts note that pain management approaches in most health facilities are still sub-optimal as patients are unable to readily access recommended medicines.

A 2016 study published in The Lancet journal revealed that whereas use of opioid drugs like morphine had grown in the developed world, their use in Africa and other developing nations was still low.

Yet, unlike wealthy countries, cancers and other chronic illnesses in developing nations like Kenya are usually diagnosed at advanced stages when pain has reached unbearable levels.

“It’s ironical that the burden of patients that need the drugs here is high, but our usage is still so low,” said David Makumi, the chairman of the Kenya Network of Cancer Organisations (Kenco).

The research, which was funded by the United Nations International Narcotics Control Board, revealed that the disparities in opioid use has created a pain divide or gap between wealthy countries and poorer nations.

The authors noted that the gap needs to be closed to enhance universal access to quality healthcare, which is a right bestowed on all human beings irrespective of their socio-economic status.

Compared to other drugs, morphine is considered as the gold standard medicine for management of severe pain in cancer care and other life threatening ailments.

But health experts concur that its availability and accessibility is minimal due to barriers shrouding its use.

Dr John Weru, a palliative medicine specialist at Aga Khan University Hospital (AKUH) noted that most practitioners shy away from prescribing morphine to patients for fear that they may become over-dependent on it.

“We need enhanced awareness so people can know that morphine is an effective and safe pain killer for patients with severe pain. And it’s not likely to be addictive or cause side effects when prescribed and dispensed properly.”

Dr Eunice Gathitu, the national palliative co-ordinator at the Ministry of Health (MOH) noted that there are certain types of opioids known to be highly addictive.

“But in the case of morphine, people should be aware that it doesn’t cause addiction when used as per the recommended guidelines. So there’s really no need to worry,” she told the Business Daily during a three-day palliative care workshop convened last week by the AKUH.

Contrary to popular beliefs that associate the drug with ‘dying’ patients or people with terminal ailments only, Dr Gathitu stated that morphine is ideal for all people with severe pain irrespective of whether they are suffering from a treatable or untreatable life threatening disease.

“After assessing patients, doctors can prescribe the drug then discontinue its use when the pain lessens or the patient recovers.”

Aside from chronic illnesses, the drug is also effective in managing severe pain after surgery as well as other critical medical procedures.

Dr Zipporah Ali, executive director of the Kenya Hospices and Palliative Care Association (KEPCA) said that the government needs to make a commitment to procure morphine powder, which can be reconstituted to oral morphine locally hence making it readily available to patients.

“The stock procured about two years ago helped very many patients in the public health sector. But it’s almost over and we don’t know what will happen afterwards.”

She added: “Having morphine is very important because if you can’t effectively manage pain in cancer and other chronic disease patients, then there is no way you can improve their quality of life.”

As a narcotic drug, the use of morphine in Kenya is highly regulated. Based on the law, it can only be prescribed by medical doctors and dispensed by pharmacists.

Persons handling such medicines must also account for each drug dispensed or sold to a different party. Any discrepancies result in stiff penalties.

Dr Makumi said that aside from creating general apathy or phobia towards morphine, such laws prohibit their use in low cadre hospitals frequented by most Kenyans that are usually managed by clinical officers and pharmaceutical technicians.

“We want the law revised to allow trained clinicians and hospice nurses to prescribe the drug then have it dispensed by equally trained pharmaceutical technicians so it can reach many patients.”

“Uganda is already doing this so there’s no reason for Kenya to lag behind.”

According to Mr Makumi, the law should be crafted in a manner that protects morphine from misuse or abuse while at the same time ensuring that it is readily accessible by patients that require it.

“That’s the kind of balance that we need.”

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