Sreelatha Menon: In praise of opium

Absence of govt policy on treatment of pain and a draconian law deny lakhs of cancer patients morphine which often is the only remedy for pain

“Relieve my pain or let me die,” said a patient at Hyderabad cancer hospital, writhing with pain. This sentiment is felt by most patients suffering acute pain. While there is remedy to prolong the life of patients suffering from terminal illnesses like cancer, a majority of doctors provide no treatment for pain. Of the 1.2 million cancer patients who die annually in the country, 80 per cent suffer severe pain. In most cases, a bit of morphine is the only remedy.

But it is a banned substance under the narcotics law and hence not easily available even for medical treatment.

Poet John Keats often wrote immortal lines in pain from tuberculosis, and for him, as for many artistes, the cure was some morphine, or “dull opiate’’ (it made his pain dull), as he called it

But in India, though morphine is cultivated and even exported for palliative care abroad, there is none available for patients in India due to a law that ignores the sick and also due to absence of a policy on palliative care.

A recent report by the Human Rights Watch accuses India of gross violation of human rights by denying patients morphine.

Here is the irony. Morphine is banned. And even if it was not, our doctors wouldn’t know what to do with it as their text books never taught them how to relieve pain.

The narcotics Act makes it illegal to possess morphine, which is the only remedy for pain in a majority of cancer cases. A model legislation was issued by the finance ministry years ago but only 14 states bothered to carry out the amendment.

But even this amendment, which makes it easy to get a licence to buy morphine, is futile.

The reason is that Indian medical colleges do not teach doctors how to lessen pain. The Human Rights Watch asks governments to draft a policy on palliative care. It also asks for inclusion of palliative care in the medical curriculum.

It is not as if the government has been blind to the agony of patients. It once took funds from the World Health Organisation, which is a forceful advocate of palliative care, and bought huge quantities of morphine between 1996 and 2003. But this morphine remained in a room in Kolkata’s Chittaranjan National Cancer Institute as regional cancer hospitals refused to take it, said the Human Rights Watch

Not all states in the country are blind to the plight of the people. In fact, when some enlightened doctors joined hands with the government in Kerala, what was achieved was a unique state-wide network of palliative care providers funded by the state and local communities.

Dr MR Rajagopal, director of Trivandrum Institute of Palliative Sciences and chairman of Pallium India, an NGO which wrought this miracle in Kerala, however, is not satisfied. He said the ideal would be palliative care becoming integrated with cancer treatment. For the disease cannot be separated from its pain. For this to happen, the Medical Council of India has to wake up and change the curriculum.

For Rajagopal and his colleagues, the struggle has just begun.