Every year, 25 million people globally die of preventable deaths from inaccessibility of pain relief, in which one in ten of them being children. These deaths contribute to half of the world’s deaths every year, according to a study reported in The Lancet medical journal—signalling a "global pain crisis".

A whopping 299 tonnes of oral morphine are distributed around the world, however less than 4% of those in low to middle income countries requiring pain relief are denied access. Morphine is generally inexpensive. Nonetheless, it differs not only in its supply; but, also in cost. In poorer countries, it is priced at USD0.16 per 10 milligrammes – as compared to just three cents in richer countries.

"The pain gap is a double-edged sword with too little access to inexpensive opioids for poor nations and misuse by rich ones," remarked study co-author Julio Frenk of the University of Miami. “Opiophobia” is definitely a concern, where the fear of allowing the drugs to be used in hospitals will lead to addiction and crime in our community.

Only a pittance to remedy morphine shortage

Experts have compiled the study by analysing the need for palliative care due to 20 life-threatening diseases. For example, HIV, cancer, heart disease, pre-mature birth, tuberculosis, haemorrhagic fevers, lung and liver diseases, malnutrition, dementia and trauma injuries. Of the 172 countries studied, 15 countries had enough to meet less than 1% of pain relief requirements, while 25 poor countries such as Haiti, Afghanistan and many countries in Africa had essentially no morphine for palliative care.

Such a state can be quickly remedied. President of the World Bank, Jim Yong Kim opined that things had to change. “Failure of health systems in poor countries is a major reason that patients need palliative care in the first place. More than 90% of the child deaths are from avoidable causes. We can, and will change both these dire situations.”

"We estimate that the cost of meeting the global shortfall of about 48.5 metric tonnes of morphine-equivalent opioids is about USD145 million per year if all countries had access to the lowest retail prices paid by some high-income countries," the study stated.

According to Felicia Knaul, the study’s co-author, who called the pain crisis a striking injustice – and that this was only “a fraction of the cost for running a medium-sized American hospital, and a pittance compared to the USD100 billion a year spent on the war on recreational drugs.”

Doctor prescribing death

Meanwhile, on the other side of the spectrum in Portland, Oregon, a psychiatrist was suspended for 30 days when his ability to prescribe controlled substances was found to be an “immediate jeopardy” to the public. This was not Dr Reinaldo de los Heros’ first offense – as he has a medical board disciplinary history dating back to the 1990s.

Dr Reinaldo de los Heros. Photo credit: Press Herald
Dr Reinaldo de los Heros. Photo credit: Press Herald

In a statement by the board, its review included information showing Dr de los Heros issued a prescription for a patient, whom he knew was incarcerated, and created a false medical record indicating there was an in-person visit to his office for 25 minutes.

Dr de los Heros was placed on probation in February 2016 when he was responsible for a patient’s overdose on his prescribed pills for numerous mental health conditions and heroin addiction. The patient, Kelly Deyo took her life in the previous year with Dr de los Heros’ 19 mostly empty prescription pill bottles around her, together with a suicide note in her apartment. MIMS

Read more:
Use of painkiller in 8-year-old organ donor’s death being investigated
Palliative care: The need to act now
The factors that lead to varied pain experiences