Cancer patients suffer as pain-relievers unavailable in country

ISLAMABAD: As around 10 million addicts in Pakistan face no trouble in getting drugs of their choice including heroin, methamphetamine, cocaine, marijuana among others, hundreds of thousands of cancer patients have to endure unbearable pain on daily basis as both the traditional and modern opioid pain-relievers are not available in the country, experts said.

A survey of various cancer-treatment facilities across Pakistan revealed that morphine, an effective but old opioid pain-reliever was very hard to acquire as it required permissions from three to four ministries and departments, while fentanyl, a synthetic pain reliever was also extremely hard to get for the cancer patients in the country.

Only oral and injectable morphine and injectable fentanyl are two powerful pain medications registered in Pakistan but it is extremely difficult to acquire them, pain medicine and palliative-care experts told The News. They said in Pakistan, there is no availability of fentanyl patches, burprenorphine, hydromorphone and oxycodone, which are used in the modern world for pain management among cancer patients and others who face severe pain due to trauma.

“Heroin, an opioid drug is easily available at every city of Pakistan in few hundred rupees, while all other kinds of illegal drugs including methamphetamine, cocaine, marijuana and even LSD are also being sold free on the streets. Unfortunately, opioid pain-killers are not allowed in Pakistan fearing their misuse, which is a paradox,” Dr Junaid Patel, a palliative-care specialist at Indus Hospital Karachi, deplored.

Around 200,000 people, including 10,000 to 12,000 children new cancer cases are reported in Pakistan every year and it is estimated that at a time, around 450,000 to 500,000 cancer patients require strong pain medications including opioid analgesics or pain-relievers to keep their pain controlled to perform their routine activities.

“Approval from several ministries and institutions is required, including the Ministry of Narcotics Control, Ministry of Interior, Drug Regulatory Authority of Pakistan (DRA) and provincial authorities to get morphine for the cancer patients, which is no more a drug of choice for pain-management for cancer patients due to its side effects. On the other hand, modern opioid analgesics being used in the world are not being registered and produced in the country,” Dr Haroon Hafeez, a palliative care specialist at Shaukat Khanum Memorial Hospital Lahore told The News on Thursday.

According to him, several new opioid analgesics or pain relievers which are derived from opium are now being used all over the world for management of pain management among cancer patients but laws in Pakistan are not permitting registration and production of these effective drugs for hundreds of thousands of cancer patients.

“Afghanistan is one of the biggest producers of opium, while Pakistan can also produce high quality opium. It is used for production of modern pain-killers and the country is doing the same and supplying those medicines and their raw material to the entire world. In Pakistan, it is easy to get illegal opium and its derivatives like heroin on the street but drugs for medicinal use for cancer patients are not available,” Dr Haroon added.

Dr Haroon claimed that due to fear of ‘misuse of medicinal opioid medicines,’ Pakistan gets the lowest quota of controlled substances in the world despite its huge population and having hundreds of thousands of patients, who face miserable, painful deaths due to apathy of officials.

Interviews with several pharmaceutical companies’ owners revealed that despite having registration for producing opioid analgesics, only two to three companies were producing these oral and injectable morphine and fentanyl, while several others were not interested in producing these drugs due to fear of raids, intimidation and harassment from Anti-Narcotics Force (ANF) as well as provincial excise department officials.

“I have the registration for producing morphine and fentanyl for pain-management but when I started producing these drugs, narcotics control authorities started treating as the main suppliers of drugs in the market. Instead of a businessman and industrialist, I was treated as if I was responsible for Pakistan’s addiction problem, so I stopped producing these medicines,” owner of a pharmaceutical company said on condition of anonymity.

He said the process for the registration of opioid medicines as well as psychotropic drugs is so cumbersome that nobody wants to apply for it as it requires years to get the registration, while the conditions of Ministry of Narcotics and DRAP also discourage companies to go for production of these controlled medicines.

“Quota for the controlled substances for opioid medicines and psychotropic drugs is issued by the Ministry of Narcotics Control. They take months to release the quota. This is the main reason behind the shortage of opioid medicines and psychotropic medicines in the country. Only people suffer due to these tactics by the authorities,” he claimed.

A senior official of the DRAP, when approached, said due to fear of investigations and cases, no official feels comfortable in dealing with medicines, which can be misused, adding that it was resulting in sufferings of the people, who need such medicines.

“There is a need for a grand dialogue between all the stakeholders to resolve this issue of shortage of controlled substances and opioid medicines in the country. People are suffering but due to fear of prosecution on baseless charges, nobody is willing to take a bold decision of allowing production of modern opioid medicines in the country,” the official added.