Pain Treatment: Millions Suffer Unnecessarily From Lack Of Medications, Human Rights Watch Says, Drug Control Part of the Problem

Millions of people worldwide are suffering unnecessarily from treatable pain, Human Rights Watch said in a report released last Friday. The report came one day before the annual observance of World Hospice and Palliative Care Day, which, not surprisingly, seeks to increase the availability of hospice and palliative care around the world. This year's theme was "Hospice and Palliative Care: A Human Right."

Tens of millions of people worldwide suffer from severe pain due to cancer, HIV and AIDS, and other health conditions. Although most pain can be treated effectively with inexpensive medications, government inaction or obstruction denies its victims access to pain treatment in many countries, Human Rights Watch said.

Governments around the world, including those in low- and middle-income countries, where the availability of pain relieving opioid medications is limited, must take urgent action to stop the unnecessary suffering, the group said. "Allowing millions of people to suffer unnecessarily when their pain can be effectively treated violates their right to the best possible health," said Diederik Lohman, senior researcher in the HIV/AIDS program of Human Rights Watch. "Policymakers worldwide can and should address this."

Low- and middle-income countries are home to half the world's cancer patients and 95% of HIV sufferers, but account for just 6% of worldwide morphine consumption. Morphine is considered by the World Health Organization (WHO) to be a safe and effective drug and one that is absolutely necessary for the treatment of severe pain. Still, some 80% of the world's population does not have access to adequate pain treatment. As Human Rights Watch noted: "This is often due to overzealous drug control efforts and poor training for health care workers."

International drug control conventions and human rights treaties mandate that countries ensure the availability of opioid drugs for pain treatment. But many countries have failed to respond, despite entreaties from the UN and the WHO. The Human Rights Watch report specifically mentioned the reluctance to treat AIDS sufferers' pain in India, the unavailability of pain relievers in Colombia, and the apparent belief by some Kenyan doctors that patients were supposed to die in pain.

"Failure of leadership is a chief cause of the pain treatment gap," said Lohman. "We know how to treat pain and the key drugs are cheap to produce and distribute. What is lacking is the will and commitment to improve access. Governments must not stand by while people suffer."

The report cited the following common problems:

• Many countries do not recognize palliative care and pain treatment as priorities in health care, have no relevant policies, have never assessed the need for pain treatment or examined how well that need is met and have not examined the barriers to such treatment.

• Narcotic drug control regulations or enforcement practices in many countries impose unnecessary restrictions that limit access to morphine and other opioid pain relievers. They create excessively burdensome procedures for procurement, safekeeping, and prescription of these medications and sometimes discourage health care workers from prescribing narcotic drugs for fear of law enforcement scrutiny.
• In many countries, medical and nursing school curricula do not include instruction on palliative care and pain treatment, meaning that many health care workers have inaccurate views of morphine and lack the knowledge and skills to treat pain adequately.

Human Rights Watch noted that the Commission on Narcotic Drugs, the lead UN agency on international drug policy, is in the midst of a review process, which it called an "opportunity to set ambitious and measurable goals to improve access to pain treatment." That would be a good first step, the group said.

"Human Rights Watch calls on all countries to develop and carry out palliative care and pain treatment policies, if they have not already done so, to review their narcotics regulations to ensure that they do not interfere with medical use of morphine and other opioid medications, and ensure that palliative and pain treatment are included in training curricula for doctors and nurses," the report concluded.