Freedom from pain--a mirage or a possibility? Experience in attempts to change laws and practices in India

The incidence of cancer increases exponentially with age and a large number of cancer patients are the older members of society. In many developing and some developed countries, the disease is usually detected at a stage when it is too late for aggressive anticancer therapy to have the desired effect. Most cancer patients suffer moderate to severe pain during the terminal phase of the disease. This pain is unpredictable and produces fear and anxiety in patients and family members. Morphine is the gold standard analgesic to control this pain, but its availability is restricted. The fear of diversion of morphine for non-medical uses has led to severe control on its availability. Studies have shown that diversion of medical morphine is not really an issue. This paper describes attempts to increase morphine availability through the courts in India. The courts have issued directives to improve the availability of the drug, yet 97% of Indian patients have very poor access to the drug. There is a need to improve access to pain-free end-of-life care. In the absence of morphine, physicians lack experience in its use. They need to be educated to provide for their patients a pain-free life. Patients and their families need to be educated that cancer need not end in a painful death. It is not adequate to be able to manage cancer alone; one needs to free the society from fear of cancer.