Patients across India who need palliative care do not seem to be getting morphine for pain management despite government initiatives that have led to simplified opioid licensing rules and increased production.

A recent World Health Organization technical report on the benefits of responsible use of medicines includes a case study on the medical use of opioids in India.  The report finds that while opioid analgesics remain underused in India, the state of Kerala has established an efficient opioid administration programme that holds lessons for the rest of the country. 

The case study looked at the policy change in Kerala and why the change could not be replicated in other parts of the country - it also makes recommendations on how other governments could improve the use of controlled medicines. The study concludes that simplifying regulations and purchasing large quantities of opioids are not sufficient. Other activities such as education and information on palliative care for all stakeholders are needed. In Kerala, opioid consumption improved by strongly embracing a national initiative, coupled with commitment from stakeholders including the local government, academia, educational efforts and strong advocacy.

An article ‘Palliative care in India lags behind government initiatives’ published in the BMJ on 9 October suggests that a national palliative care policy is needed for India. The article quotes Stanley Macaden, coordinator for palliative care with the Christian Medical Association of India and the head of the association’s task force drafting a national policy  as saying  “A national policy will help integrate palliative care into healthcare services, making it obligatory on institutions to establish facilities and follow certain standards.” The article also suggests palliative care has not received high priority because, as it “is neither a glamorous nor a remunerative field of medicine.”