Push for expensive opioids worries palliative care experts

Dec 06,2023

Palliative care associations and experts across the world have flagged the trend of pharma industry subsidies and promotions in some low- and middle-income countries (LMICs) like India making expensive opioids such as sustained release morphine or fentanyl patches available, while inexpensive and widely applicable immediate-release oral morphine remains inaccessible.

"Immediate release oral morphine is inexpensive. In Pallium India, we procure it for free supply to patients at an average cost of less than 10 rupees a day per patient. A fentanyl patch, which lasts up to three days, works out to be about 12 times as much per day. The palliative care community, which has been generally in the non-governmental sector so far, has stuck to oral morphine except when more expensive opioid medications are needed," explained Dr MR Rajagopal of Pallium India, one of the signatories to an updated morphine manifesto it created in collaboration with the International Association for Hospice and Palliative Care.

The manifesto endorsed by palliative care associations across the world, which was released on Tuesday, called for governments to ensure the safe accessibility of immediate-release oral morphine to patients in need, like cancer patients, people with some respiratory and neurological ailments and others who need urgent pain management and often need it for life.

"Unfortunately, there is a global trend to resort to more expensive medications. In India, we have a medicine called fentanyl belonging to the same class as morphine. Fentanyl is given either intravenously (by an expert) or for the long term as a patch over the skin (transdermal). In our institute, this works out to about 12 times the cost of immediate release morphine. This can cause financial destruction of families that are already subjected to catastrophic health expenditure by treatment of the disease. Also, fentanyl is not suitable for initial titration at all. There is no way to guess how much one patient would need," stated Dr Rajagopal.

According to the manifesto, the marketing and distribution of brand-name, expensive opioids over cost-effective generic formulations of immediate-release oral morphine hinder access to pain relief for the vast majority of patients in LMICs, and patients and families who purchase them experience increased financial toxicity.

"The standard practice should be to initiate treatment with immediate release morphine, to increase the dose every other day till adequate pain relief is achieved." explained Dr Rajagopal.

Source: Healthworld