Poor countries throughout the rest of the world have an entirely different story.
The study, conducted by The Lancet Commission on Global Access to Palliative Care and Pain Relief, found that the needs for pain management and palliative care remain unmet in many developing nations. The study said more than 25.5 million people, including 2.5 million children, die every year globally with serious health suffering that requires palliative care. An additional 35.5 million people live with unmanaged chronic pain conditions.
Nearly 80% of deaths requiring palliative care in low-income countries are preventable with adequate prevention, treatment and care interventions. Mexico meets 36% of its need, China 16%, India 4% and Nigeria 0.2%.
In numerous countries, oral morphine isn't available, even though it's affordable. According to the report, off-patent, immediate-release morphine costs about 3 cents per 10 milligrams.
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The absence of morphine, essential in palliative and end-of-life care, in many low and middle-income countries is "emblematic of the most extreme inequity in the world", the report states. They analysed 20 life-threatening and life-limiting health conditions (including HIV, cancers, heart disease, injuries and dementia) and 15 corresponding symptoms (including pain, fatigue, wounds, anxiety and depression) that were most frequently associated with the need for palliative care and pain relief.
The Lancet panel looked to lessons from the US opioid crisis, and from Western Europe, which has avoided similar abuse thanks to strict opioid monitoring and to universal health coverage for non-opioid treatments for chronic pain, said report co-author Dr. Lukas Radbruch, a palliative care specialist at Germany's University of Bonn. The study said that though off-patent cheap immediate-release morphine for pain relief costs as little as three cents per 10 mg and is an essential component of palliative care, less than one per cent of the world's supply went to low-income countries where the need was the greatest.
"The fact that access to such an affordable, essential, and effective intervention is denied to most patients in low-income and middle-income countries and in particular to poor people.is a medical, public health, and moral failing and a travesty of justice", the authors of the paper write. "Unbalanced laws and excessive regulation perpetuate a negative feedback loop of poor access that mainly affects poor people", they write in the paper.
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