Prisoners of Pain

Last month, an Egyptian court sentenced Laura Plummer, a 33-year-old saleswoman from England, to three years in prison for trafficking 320 tramadoles in the country. Tramadoll is an opioid prescribed medicine, available in the United Kingdom for pain relief. This drug is forbidden in Egypt because it is massively abused in this country. Plummer said she was sending medicine to her Egyptian boyfriend, who suffers from chronic pain and that she did not know she was breaking the law of Egypt.

Media in the United Kingdom have been very attractive in reporting on Plummer's suffering, despite the fact that she was caught at a higher rate than a doctor might prescribe in the United Kingdom.

But no matter how right or wrong Plummer's sentence is, the case sheds light on a matter with far broader consequences.

Last October, the Commission for Paul's Care and Relief of Lancet's Pains published an impressive 64-page report arguing that the relief of severe pain is a “The commission is not the first to issue such claims, but the report brings together many evidence demonstrating the seriousness of the problem. Each year, 25.5 million people die in agony because of a lack of morphine or drugs to relieve severe pain. Only 14 percent of the 40 million people who need physical care receive such medicine.

The report begins with a doctor's account of a man suffering terrible lung cancer. When the doctor gave him morphine, he was surprised by the difference; but when the patient returned a month later, the nursing service was not in a condition of morphine. The man said he would return a week later with a rope; if he could not take the pills, he would hang himself in a tree in front of the hospital. The doctor commented: “I believe he was serious. ”

Citizens of rich countries are familiar with the news that opioids are too easy to find. In fact, according to data from the International Board for Narcotics Control and the World Health Organization, access to these drugs is extremely uneven.

In the United States, therefore, the amount of available opioids with effects similar to morphine on pain is three times higher than the needs of patients in job care. In India, where the incident with the patient who threatened to hang himself is only four percent of the quantity required; in Nigeria only 0.2 percent. People in the U.S. suffer from overexcessive giving of prescription opioids, while people in developing countries suffer exactly the opposite.

Although it is generally the poor who do not have access to opioids, the main problem is not, at least in this case, the cost: once-use morphine doses cost only a few cents of the dollar. Lancet's Commission argues that “The essential” drug package can cost low-income countries only 0.078 dollars per capita annually. The total cost of closing “hendek of pain” and providing all the necessary amount of opioids can be only $140 million a year if we count them at the lowest retail prices (in an unfair way, opiums are often more expensive in poor countries than in rich countries). In the context of global health spending, this is a drop of water in the ocean.

People suffer because pain relief is not a priority in public politics. There are three basic explanations for this. For starters, medicine is more focused on keeping people alive than on preserving their quality of life. And patients suffering a few months of agony at the end of their lives are not well-placed to seek better treatment. The third and perhaps most important is opium. The mistaken fear that allowing the use of opioids in hospitals will feed dependence and crime in the community has resulted in severe restrictions on their use and health workers are not trained to use them when needed.

Although opioids can be harmful and addictive, as the current crisis in America demonstrates, the fact that something can be dangerous is not enough reason to impose extreme restrictions on clinical use. Risks are justified when the expected benefits obviously overcome the expected damage. Policymakers in developing countries are making an election to impose what WHO calls <x0 micro-restrictive disorder” on morphine and other essential medicines for job care. Low or zero access is not justified from a medical or moral standpoint.

The design of a system that provides adequate access to morphine without promoting prescription oversumption or drug leaks on the black market is a difficult job, but not impossible. The Lancet Commission draws attention to the Indian state of Kerala, where trained volunteers are at the center of community rehabilitation, empowered by international co-operation with WHO, university researchers and nongovernmental organisations. There is no interest in overindulgence of prescription drugs, nor is there evidence of the deviation of opioids in the black market.

Another model worth studying, the Commission says, is Uganda, where an OJF-led centre supplies the national public system with oral morphine.

Drug trafficking by Laura Plummer was obviously crazy; her experience in an Egyptian prison would be a personal tragedy. But if her story is true, she is also the victim of excessive restrictions on the use of opioids, which prevented her boyfriend from getting the tramadeol legally.

Plummer's case as a result points to a broader disaster: what so many citizens in developing countries are denied effective relief of pain by governments occupied by opium. This is not just crazy; in the words of the Lancet Commission, this is also a “medical punishment, public health and a moral failure, as well as a failure of justice.” /Project Syndicate/reporter.al/