2015; Volume 16, No 5, May

Global Palliative Care Community Highlights – the column that brings you initiatives from across the world

Act, amendment and availability – bridging the gaps

Dr. Sushma Bhatnagar, MD, Professor and Head, Department of Pain and Palliative Care, All India Institute of Medical Sciences, New Delhi, India, and a member of the IAHPC Board of Directors.

Dr Sushma Bhatnagar

“I am not afraid of cancer but pain”

Pain management has been declared as a ‘Fundamental human right’ and it is critical to avoid pain to allow patients to die with dignity. Yet, more than 90% cancer patients suffer and die in pain.

The mere passing of the amendment of The Narcotic Drugs and Psychotropic Substances Act (NDPS) by the Government of India is not going to make any change to the existing scenario. The challenges are many – this I have realized after coordinating the workshop on ‘Implementation of the National Program on Palliative Care (NPPC) and NDPS Amendment to Improve Access to Opioids’, which was held at the Indian Association for Palliative Care National Conference (IAPCON) 2015 in Hyderabad on 13-15 February 2015, organized by Dr. Gayatri Palat. Attended by drug controllers of 16 states and the health secretary of three states, the workshop received satisfactory representation from cancer centers and pharmaceutical companies, and excellent representation from overseas faculties.

The challenges I perceived:

• Different states have different rules; they are not aware about the recent amendment of NDPS Act.
• The opiophobia of narcotic prescription still persists.
• A need for training and teaching at every level amongst healthcare workers.
• Reluctance on the part of pharmaceutical companies to manufacture a large quantity until the rules are relaxed; they also still feel insecure, which could indicate major obstacles ahead.

A multipronged attack aiming to increase availability (by easing the rules), awareness and demystifying the facts is required to curb the rising deficit.

Recommendations from different groups were:

• Central government should privatize the cultivation and production of opioids by granting licenses to private enterprises.
• The procedure for investigations needs to be different for legitimate entities and an illicit trafficker.
• A single nodal agency needs to be constituted to license, monitor and control legitimate entities, under the act.
• All states should have a state palliative care policy.
• Doctors who are using morphine for pain relief should be able to work in an environment that gives them the confidence to use it without fear.
• Licenses provided to hospitals and pharmaceutical companies should be valid for a longer period and a minimum of five years.
• Under the state policy, there is a need for narcotics, which should include training and education at all levels of doctors, nursing staff and paramedical staff.
• There should be a system that can provide opioids to the needy in their own homes.

We have to make proper and meticulous guidelines. There is a huge need to take charge and provide leadership at all levels – medical, industry and social. It is a human right and the duty of us all to ensure that no one is denied pain relief due to unavailability of the drugs, or lack of knowledge. We should all strive for the same goals until such time as we achieve our goal of a ‘Pain free India’.

Dr. Sushma Bhatnagar.
Email: [email protected]

Dr Bhatnagar is a member of the Board of Directors of the IAHPC; read her bio here.

Editor’s note: A recent article on the Narcotic Drugs and Psychotropic Substances Act, published in the Indian Journal of Medical Ethics, is discussed in this month’s Media Watch column.

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