20 October 2017

Cheaper drugs can reduce suffering in poor countries

If drugs like morphine were cheaper in lower-income countries, more people would be able to die without unnecessary pain.

Chronic pain is an unfortunate side-effect of many serious diseases.

Tens of millions of people worldwide who die in severe physical and mental distress each year could have an easier death if low-cost pain drugs were available in their countries, a new report says.

Children account for more than 2.5 million of the almost 26 million people with serious illnesses who receive no palliative care or pain relief, according to the report.

What the data entailed

The findings came from an analysis of data on the care provided in 172 countries for people with any of 20 serious conditions, including HIV, cancer, heart disease, premature birth, tuberculosis, haemorrhagic fevers, lung and liver disease, malnutrition, dementia and trauma injuries.

Of the 61 million people who endure severe physical or psychological suffering and pain each year, about 83% live in 100 low- and middle-income countries where there's little or no access to low-cost, off-patent morphine, according to the report, issued by The Lancet Commission on Global Access to Palliative Care and Pain Relief.

In high-income countries, the drugs costs 3 cents per 10-milligram dose, but the commission noted that in low-income nations, that amount costs 16 cents, where and when it's available.

The report further noted that just 10.8 metric tons (3.6%) of the 298.5 metric tons of oral morphine distributed worldwide go to low- and middle-income countries.

The commission's report appeared in The Lancet medical journal.

A global health emergency

"The pain gap is a massive global health emergency which has been ignored, except in rich countries," commission chair Felicia Knaul, a professor at the University of Miami Miller School of Medicine, said in a journal news release.

"This global pain crisis can be remedied quickly and effectively," she said. "We have the right tools and knowledge and the cost of the solution is minimal. Denying this intervention is a moral failing, especially for children and patients at the end of life.

"If low- and middle-income countries could obtain morphine at the same price as rich countries, the annual global price tag for closing the gap in access to oral morphine would be $145 million (±R1.95 billion), a fraction of the cost of running a medium-sized US hospital," Knaul said.

"This is a pittance compared to $100 billion (±R1 345 billion) a year that the world's governments spend on enforcing global prohibition of drug use," she added.

"The biggest shame is children in low-income countries dying in pain, which could be eliminated for $1 million (±R13.5 million) a year," Knaul said.

The problem is greatest in eight countries with the highest populations: China, India, Pakistan, Nigeria, Bangladesh, Russia and Mexico, the report said.

"We can ensure that the 61 million people a year who need it get palliative care," Knaul said. "The alternative is unacceptable and unthinkable.

The situation in South Africa

Pricey medicine is also a cause of concern in South Africa. According to a report published on Health24 in March 2016 there were several factors contributing to the rise in cost of quality medical care in South Africa. These included:

  • Cost of medical products increased by 4.9% over the last year
  • Lack of foreign investment in SA
  • Low job creation and increased unemployment
  • Rising debt levels
  • Depreciation of the South African rand
  • High cost of imported medication
  • Price increase of 4.8% for pharmaceuticals
  • Deep segregation between private and public healthcare facilities

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