Published on: September 16, 2011

Short Film 18 of 50 in the LIFE Before Death documentary series about the global crisis in untreated pain and the dramatic life changing affect palliative care services can deliver to patients and their families around the world.

In “A Little Goes A Long Way” we discover how inexpensive essential pain medicines like morphine are to produce and why this actually presents a barrier to access for many around the world.

“People have perceived that pain relief is a luxury that in developing countries that we cannot afford,” states Dr Natalya Dinat (South Africa). “I would challenge that quite vigorously because I think it’s an absolute essential for many reasons.”

Opium poppy manufacturer Jarrod Ritchie (Australia) displays what raw processed morphine looks like. “This is the product that at the end of the day all the hard work goes into — which is morphine — which has been around for two thousand years. It’s still considered the gold standard in pain relief. The best part about it is that all the hard work’s done by nature.”

“It is one of the cheapest medications that we could have, ” explains Dr MR Rajagopal (India). “All of the pain medications in [India] – including the cheapest paracetamol – all of the medications are more expensive.”

“We can do a therapeutic dose for under one cent,” states Ritchie.

“In 2002 the Government expenditure on health was seventy-two dollars per person [in Uganda],” reflects Dr Henry Ddungu (Uganda). “Now if you add on the cost of morphine per patient to reach pain control, it won’t even reach seventy-five dollars.”

“We know it’s not a matter of needing to invest a lot of money in inventing new drugs — we have it,” implores Mary Callaway (USA).

“Maybe if it was more expensive, the industry would be more interested in it,” ponders Dr Rajagopal.

“From a pharmaceutical company stand point there’s no money to be made in morphine,” explains Callaway. “So what they want to do is bring in expensive fentanyl patches or some technology because that way they can make money.”

“Many hospitals in [India] have transdermal fentanyl but not oral morphine because it’s expensive, the profit margin is better,” states Dr Rajagopal.

“So unless you can figure out a way to bundle it with other drugs you can’t get pharmaceutical companies to import it or manufacture it,” protests Callaway.

“Fortunately Cipla — one of the Indian pharmaceutical companies — as a charity measure is making it at no profit,” reveals Dr Rajagopal. “So it is available at very little cost — something like twelve cents of American money would give eight days pain relief for an average patient.”

“In a country like Jordan what we found was fentanyl patches were available to anyone who can buy them,” reflects Dr Kathleen Foley (USA). “But buying a fentanyl patch was a nursing salary for a month. So availability and access are two very different things. There was a major effort to make oral morphine available, with the help of a local pharmaceutical company, to cancer patients in their national cancer centre and this has now happened.”

“It’s immensely satisfying to see somebody who has been in pain for the last three months suddenly start smiling,” concludes Dr Suresh Kumar (India).

Featuring Dr Natalya Dinat (South Africa), Jarrod Ritchie (Australia), Dr MR Rajagopal (India), Dr Henry Ddungu (Uganda), Mary Callaway (USA), Dr Kathleen Foley (USA), Dr Suresh Kumar (India).

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If you’ve missed previous episodes, catch up on the LIFE Before Death website…