India: Provide Access to Pain Treatment

India’s Obligation to Ensure Palliative Care – Government Inaction, Restrictive Regulations Condemn Hundreds of Thousands to Unbearable Suffering

Published on Human Rights Watch HRW, October 28, 2009.

Download the report: Unbearable Pain: India’s Obligation to Ensure Palliative Care, 95 pdf-pages;
Same with cover, 97 pdf-pages;
Download Photo Feature, 21 pdf-pages.

And watch this video: Right to Relief, Palliative Care in India, 3.20 min.

(New Delhi) – Hundreds of thousands of patients in India unnecessarily experience excruciating pain, Human Rights Watch said in a report today. Restrictive drug regulations, lack of training for health care workers, and poorly integrated care result in needless suffering for patients because they cannot get inexpensive and effective pain medications …  

… The report identified three key obstacles to improving the availability of pain treatment and palliative care:

  • Restrictive drug regulations. Many Indian states have excessively strict narcotics regulations that make it very difficult for hospitals and pharmacies to get morphine. In 1998, the central government recommended that states adopt modified regulations, but more than half of India’s states have not done so.
  • The failure to train doctors. Most medical students and young doctors receive no training on pain treatment and palliative care because the government does not include such instruction in relevant curricula. As a result, most doctors in India simply do not know how to assess or treat severe pain.
  • Poor integration of palliative care into health services. National cancer and AIDS control programs do not contain meaningful palliative care components, thus depriving such care of public funds and relegating it to second-tier status.

“India is one of the world’s largest legal producers of opium, the raw material for morphine,” Lohman said.  “But almost all of it is exported while hundreds of thousands – if not millions – of Indians suffer needlessly.”

The report focuses specifically on the availability of pain treatment for cancer patients. It says that, based on official morphine consumption reports, fewer than 4 percent of patients with advanced cancer have access to appropriate pain treatment. The report also says that increased government funding for cancer has not emphasized palliative care.

“The Indian government deserves credit for investing in regional cancer centers and increasing funds for cancer control,” Lohman said. “But without specific efforts to ensure that all cancer hospitals can treat pain and offer palliative care, these funds will do little to relieve the suffering for patients with advanced, incurable cancer.”

The report is the first by an international human rights organization to examine access to pain relief medicines from a rights perspective. Human Rights Watch believes that governments have an obligation to ensure that essential medicines, including morphine, are available to patients and that health care workers receive adequate training in their use. The report says that the failure by the Indian government to fulfill this obligation violates the right to health … (full text).

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