Throw out opium, which the Creator himself seems to prescribe, for we often see the scarlet poppy growing in the cornfields, as if it were foreseen that wherever there is hunger to be fed there must also be a pain to be soothed; throw out a few specifics which our art did not discover, and it is hardly needed to apply; throw out wine, which is a food, and the vapors which produce the miracle of anaesthesia, and I firmly believe that if the whole materia medica [medical drugs], as now used, could be sunk to the bottom of the sea, it would be all the better for mankind,—and all the worse for the fishes. — Oliver Wendell Holmes, ‘Currents and Counter-Currents in Medical Science’, Address to Massachusetts Medical Society (30 May 1860).

Morphine is in the “Essential Medicine list” of the World Health Organization.  And, it’s importance is even understood in the art world, see this design by Dan Golden:

Each one of us is a potential patient; it is very likely that we shall need it some time in our lives. 

Is it not time we stood up and asked our hospitals,

“Does your pharmacy have oral morphine?  If not, what kind of a hospital are you running, without even essential medicines?”

In preparation for next month’s UN Summit on NCDs, the Indian Government’s Ministry of Health & Family Welfare and WHO India organized a 2-day National Summit on Noncommunicable Diseases, August 23-24, in New Delhi (press release). More than 200 delegates from various fields related to NCDs attended the meeting (programme).

During the inaugural function Mr RK Srivastava, Director General of Health Services, mentioned palliative care as one of the target areas of his department.

Minister for Health & Family Welfare, Mr Ghulam Nabi Azad, announced his ministry’s plans to launch home visit program for bed-bound patients in 100 districts in the country.

Our collective action is bearing fruit!

One of the most painful sights in many hospitals is that of children with cancer, HIV, burns or other accidents – all going through intolerable and needless pain.

WHO’s Research Agenda for the Treatment of Pain in Children

The World Health Organization aims to revise and publish an updated version of the 1998 guidelines Cancer Pain Relief and Palliative Care in Children (pdf) with an addition of other medical conditions with persisting pain: later this year, the WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses will be published.

A part of this guideline entails WHO’s research agenda, which highlights critical research topics of paediatric pain treatment. The research agenda was recently published. The article calls on researchers to focus their studies on one of the proposed topics.

Download: WHO Calls for Targeted Research on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses (pdf)

Research areas that need critical attention are: clinical studies on paracetamol, NSAIDs and opioid analgesics; clinical studies on adjuvant medicines (antidepressants, gabapentin, and ketamine) for neuropathic pain; safety and dosing of non-opioid and opioid analgesics in different age groups as well as dose conversion of opioids; and pain assessment tools for children.

In addition to the pharmacological research that is proposed in this WHO publication, we hope there will also be enough social research about getting the available science to reach the needy.

Is that not the major cause of unalleviated pain in the world – the failure of available knowledge to reach the needy?

Poonam and CanKids

Pallium India is proud to report that as part of its “We Can, We Should, We Will Conquer Cancer” campaign, the American Cancer Society (ACS) has selected Ms Poonam Bagai as one of two Indian Global Cancer Ambassadors.

Poonam, herself a cancer survivor, is President of CanKids and vice-chair of Pallium India. Her selection as a Global Cancer Ambassador is based on her dedicated work in these areas over the last few years.

During June, along with other select Global Cancer Ambassadors, she will travel to New York to be trained by ACS on meeting with UN mission representatives and decision makers, and on advocating to make cancer a health priority in India and globally.

UN High-level Meeting on NCDs

ACS’s training sessions are in preparation for the UN High-level Meeting on non-communicable diseases (NCD) prevention and control, which convenes in September 2011. She will also meet with the Indian Mission to the United Nations to put forward specific requests to be presented at the Meeting.

The UN High-level meeting will bring together heads of state and other high level political figures to discuss NCDs (cancer, diabetes, cardiovascular disease, chronic respiratory disease) and create international policy guidelines to address NCDs. The Global Cancer Ambassadors are integral to implementing these guidelines.

TOBACCO’S TOLL…

ONE death every SIX seconds
~ 6 million people die from tobacco use and exposure to tobacco smoke

63% of all deaths
are caused by noncommunicable diseases, for which tobacco use is the 2nd greatest risk factor

• Take the World No Tobacco Day quiz
• Visit the WHO’s World No Tobacco Day website
• Download the flyer
  
• Don’t forget about India’s own “Chew On This” campaign for a Tobacco Free India:

Dr Kathleen Holloway

Dr. Kathleen Holloway, Regional Adviser in Essential Medicines WHO South East Asia Regional Office, gave an illuminating talk during the National Initiative in Patient Safety workshop at India Habitat Center, New Delhi on 8 April 2011.

During her talk on Safety in Drug Use, she quotes from the World Health Organisation’s Rational use of medicines:

Rational use of medicines requires that patients receive medications appropriate to their clinical needs in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and the community.

That being the ideal, she points out the global estimated reality today:

• More than half of all prescriptions may be incorrect
• More than half of all patients fail to take them correctly
• In primary care, less than 40% of patients cared for by health professionals in the public sector and less than 30% in the private sector are treated in accordance with clinical guidelines.
  (Source: WHO 2009)

It is almost unbelievable!

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• You can find out more on this topic at the WHO’s Rational use of medicines website…

India: The principle of balance to make opioids accessible for palliative care

In the state of Kerala in South India, Dr M R Rajagopal has been working in the field of ‘Palliative Care’ for over twenty years. As the Chairman of Pallium India, he and his team have been working to increase the availability of such drugs for patients. UNODC South Asia interviewed him to understand the dimensions of the situation in India and also some of the effective solutions that have been tried to improve access to these drugs, while ensuring that they are not diverted for illicit purposes.

The questions asked by UNODC:

1. Please explain what is Palliative Care. How does it relate to drug control?
2. What is the scenario regarding the availability of these opioid drugs in India?
3. Can you explain what these regulatory procedures are?
4. You have been working in this area for over twenty years. Can you share some of your experiences and some good practices that are being followed?
5. What do you think needs to be done further to increase availability of opioids for palliative care?

Read the full interview & answers to these questions on the UNODC blog…

We have good news!

The Government of India Department of Revenue has always been proactive in the matter of opioid availability. Initiatives by David Joranson, his team and partnered by Indian palliative care workers (since 1994 and continuing now) were so well-received by the department that the 1998 recommendations for model rules  have now been accepted by 14 states in India.

Additional support came in the last few years from the WHO’s Access to Essential Medicines programme pioneered by Dr Willem Scholten, advocacy by Human Rights Watch, the positive approach from the International Narcotics Control Board (INCB) and from many other sources, not to mention the persistent and continued support from David Joranson and his team.

Recently, Mr Pavel Pachta, who heads INCB, visited India and had meaningful interactions with stakeholders in the field.

On the 1st and 2nd of February 2011, the Department of Revenue conducted a two day conference in Parliament House Annexe. There were about 100 participants – almost every state was represented by their Drug Control and Excise departments. One half day was spent on deliberations about availability of opioids for medical purposes.

The very fact that the meeting dedicated so much time to this subject shows the importance that the department is giving this issue. In general, the meeting agreed on the following matters:

Instead of only “morphine for cancer pain”, the model rules of the Department of Revenue hereafter would recommend the availability of “opioids for pain management”.

• This would mean that in future we should be able to access opioids other than morphine for treatment of severe pain conditions, when the patient does not tolerate morphine.

The Drug Controller General of India would initiate the process for making methadone available in the country.

• At the moment, it is manufactured in India for export, but not sold in the country.

The Department of Revenue will work with State Governments to simplify their narcotic regulations and to put in simple standard operating procedures.

Dear All, Happy to inform you that Institute of Palliative Medicine has been designated as a World Health Organization Collaborating Center (WHOCC) in Palliative Care. IPM becomes the fifth WHOCC in Palliative Care in the World and the first one in the Developing world. We hope that this important designation to a center in India can be used to strengthen the evolving national palliative care initiative in the country.

Regards,
Dr Suresh Kumar
Director, WHO Collaborating Center for Community Participation in Palliative Care and Long Term Care

In 2003, they started home visits and a few years back, an inpatient wing for palliative care was added.  The work involves both the hospital and the community and out of about 100 volunteers, about 20 attend to the work on a regular basis.

The institution celebrated its 10th anniversary on 01 May 2010.  The festivities started with a rally by school students, scouts & guides and volunteers followed by a public meeting.  The most noticeable feature was the joy and enthusiasm of the team of volunteers.  Their sense of achievement and fulfillment were obvious.

Best wishes Lisa PPCS!

Institutions like yours have a special place in development of palliative care in the country – that of integrating hospital based practice with community based work.