Morphine shortage deepens the pain for cancer patients

Only one in ten cancer patients in public hospitals has access to morphine, the essential pain control drug that is recommended for patients in palliative care, a new survey by the Ministry of Health has revealed.

The Kenya Harmonised Health Facility Assessment report for 2018/19 indicates that cancer patients have to buy their own morphine or take the less effective paracetamols that are mostly available in both public and private hospitals across the country. The survey ranked the national availability of paracetamol at 77 percent compared to 10 percent for morphine.

Even the few patients who have access to morphine have to contend with irregular supply of the drug as the country lacks systems to ensure regular supply.

In most instances, and when the drug is available, patients receive the morphine at no cost but in private hospices they are sometimes required to pay about Sh500 for a 100ml solution for a week’s supply.

For many years, morphine has been on the World Health Organisation (WHO) model list of essential medicines as the strong opioid of choice because of its suitability for management of moderate to severe cancer pain. Pain relief medications are recommended for cancer patients undergoing treatment, especially chemotherapy and/or radiotherapy, or those experiencing pain caused by malignant tumours.

The prevalence of Ibuprofen drug, which is usually administered to deal with moderate pain, and Hyscine butylbromide injection, that is used to ease bloating and spam-type pain in the stomach, intestines, bladder and urethra, is at 63 and 58 percent availability respectively.

“Nationally, paracetamol was the most available tracer item for palliative care, at an average of 77 percent, while Lorazepam tablets was the least available at an average of two percent,” the report says.

Zipporah Ali, a palliative care doctor and executive director of Kenya Hospices and Palliative Care Association (KEHPCA) says the country has had a morphine stock out since June last year and patients have since been at the mercy of well-wishers. The well-wishers extend financial aid to enable the association purchase the drug while institutions like the International Cancer Institute donate the drug.

“It is a scary period for the patients; the pain is too much to bear and some drugs like Ibuprofen and paracetamol don’t really help,” said Dr Ali. “Last week, we were told that a consignment has arrived in the country. We hope Kemsa (Kenya Medical Supplies Authority) can release it as fast as possible. But this will only fix the problem for a short while. What the country needs is sufficient well co-ordinated systems so that we never suffer stock-outs needlessly.”

Cancer patients in Kenya receive an oral morphine solution through hospices and county-run hospitals. The health institutions receive their supplies from Kenyatta National Hospital (KNH), which is tasked with the preparation and distribution of the drug with the help of KEHPCA.

Currently, there are about 71 palliative care centres in the country, compared to over 2,900 private and public health institutions. Only two centres exclusively cater to children with cancer.

KEHPCA estimates that about 1.5 million Kenyans are in dire need of palliative care, but less than 10 percent have access.

According to a Lancet Commission on Global Access to Palliative Care and Pain Relief report, about 80 percent of deaths requiring palliative care in poor countries can be prevented if the patients receive treatment and care.

Most common cancers in Kenya are cervical, which claims nine lives every day, breast and esophagus for men and prostate cancer for men. A majority of these patients are diagnosed in the late stages when they need end-of-life care.

The 2018 report by the World Health Organisation’s International Agency for Research on Cancer says about 47,887 people get cancer annually in Kenya while 32,987 die from it every year.