Based on an estimate of the morphine it would need in 2009, Burkina Faso ordered 153 grams (0.34 pound) of the drug, enough to treat the pain of eight terminal cancer patients. That year in Burkina Faso, 23,000 people died of cancer.
The situation is not much different in most of the developing world. Although morphine is cheap -- it costs as little as 30 cents a day to treat a cancer or AIDS patient -- almost 90 percent of the global supply is consumed in North America and Europe, while the entire developing world uses 6 percent. Because governments in poor countries have not made pain relief a priority, four out of five people worldwide have inadequate access to the opioids necessary to treat moderate or severe physical suffering.
The number of people who go without these medicines is growing as the global burden of cancer shifts to the developing world. Over the next 20 years, cancer deaths are expected to remain fairly stable in wealthy countries while increasing 62 percent in poor ones.
To get pain relief to those who lack it, developing countries need to increase their opioid estimates. The International Narcotics Control Board, which monitors United Nations drug control conventions, grants governments import approvals based on how much of each substance they say they’ll require. In 2009, Benin asked for only enough morphine to cover 0.5 percent of those who needed it, based on estimates by researchers using World Health Organization statistics on terminal cancer and AIDS patients. Egypt requested only 3 percent, and the Philippines, 8 percent.
Then there’s the challenge of delivering the medicine to patients. Typically, developing countries pile restrictions on top of the international requirement that opioids be made available only by prescription. Some governments limit prescribing power to specialists or to panels of doctors, or require health ministry approval. Some restrict the institutions that can dispense the drugs. These add-ons should be stripped back.
Governments often fear that reducing regulations will lead to patient addiction and illicit use. Drug dependence isn’t an issue for those who most need opioids: patients in the late stages of terminal illness. Used as prescribed, opioids normally don’t produce a high; what they do is enable patients to become communicative and find a measure of comfort in their final days.
Moreover, morphine poses relatively modest abuse risks. It doesn’t produce the euphoria of newer opioids such as OxyContin, which are rampantly abused in the U.S. And those drugs are too expensive for the developing world. Though some people will inevitably abuse morphine, the alternative is to abandon millions of others to unrelieved agony.
Experience shows that all these reforms can be accomplished. Uganda and Vietnam have eased restrictions limiting opioid availability. They, as well as India, Kenya and South Africa, have started training medical practitioners in pain management.
The painkiller gap hasn’t attracted as much attention as the fights against illnesses such as malaria or AIDS: It’s not about saving lives, and progress will require great patience. Once the right policies are in place, it will be possible to do a world of good with an inexpensive dose of old medicine.
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