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Cry for law to help ease cancer pain

New Delhi, Nov. 25: Nagesh Simha, a palliative care physician in Bangalore, has spent each session of Parliament over the past year glued to Lok Sabha TV, hoping a pending bill gets passed so that India’s cancer patients get better pain medication.

Simha is among doctors waiting for the government to revise narcotics rules to make morphine available to end-stage cancer patients, amid concerns that hundreds of thousands of such patients across India receive inadequate pain medication.

The Indian Association for Palliative Care (IAPC) this week issued a fresh call to the government to speed up passage of the bill amending the Narcotic Drugs and Psychotropic Substances Act, easing for hospitals the process of procuring morphine for terminally ill patients. The bill was introduced in 2011.

“The coming (December) session of Parliament is possibly our last opportunity to see the bill passed,” Simha, the IAPC president, told The Telegraph. “We’ve been waiting for changes in rules for over a decade — we don’t want the bill to lapse.”

IAPC members, speaking on the sidelines of the Indian Cancer Congress here yesterday, had said the existing rules for procuring morphine are so complex that most hospitals treat patients with inferior pain medication options or refer them to distant hospitals.

“We estimate that only about one per cent of patients in India with end-stage cancer are receiving appropriate pain management through morphine,” said Sushma Bhatnagar, head of the palliative care department at the All India Institute of Medical Sciences, New Delhi.

The current rules require hospitals to obtain five licences — two from excise commissioners, two from state drug controllers and one from the transport department — to buy morphine.

“Even when we get the five licences, things at times don’t work out. By the time one licence comes through, another has lapsed,” said a doctor.

India is one of the largest producers of poppy in the world and exports morphine to several developed countries. “It’s particularly frustrating that patients in India are denied access to morphine while we export it for the benefit of patients in other countries,” Simha said.

In the absence of morphine, many doctors are forced to prescribe patients other pain-relieving medications that don’t offer the same advantages as morphine.

“Most other pain medications have a ceiling dose — an upper limit that can’t be crossed because of the risk of side effects,” said Simha. “The beauty of morphine is that it has no ceiling dose; you can tailor the dose as required to manage the pain.”

While morphine has an addictive potential, palliative care medicine specialists say, its use in terminally ill patients is justified.

Although the Centre and 14 states have amended rules, easing the procedures for hospitals to obtain morphine, these states cover less than half of India’s population.

The bill will introduce a uniform and single-window procedure that is expected to prompt many more hospitals to begin procuring morphine.