For the patient in pain who does not tolerate morphine very well (a proportion of patients may not, for genetic or other reasons), we have had no other opioid pain killer available for oral use in India. In most of the countries, they switch from one opioid to another when one is not well tolerated. But in India, if you cannot tolerate morphine, well, tough luck. Of course, 99% of Indians have been putting up with even lack of access to morphine; so who bothers about the minority who can get morphine but do not tolerate it?
Finally there is a ray of sunshine. The efforts of a lot of people seem to have paid off. Access to methadone has been approved by the government of India by the gazette notification in May 2015. Now we understand that the Drug Controller General of India has approved methadone tablets and syrup for sale for pain relief.
A word of caution to all palliative care people in India: Most of us are not familiar with the medicine. Methadone needs to be understood; then it will help us.