Painkillers in Short Supply in Poor Countries                 A
survey of specialists in Africa, Asia and Latin America has produced a
disturbing portrait of the difficulties in offering pain relief to the
dying in poor countries. Many suffer routine shortages of painkillers,
and the majority of specialists got no training in pain relief or
opioid use during their medical education.        In Africa, the report said, 
20 percent of all palliative care specialists had no access to
 morphine or other strong opioids, and 25 percent never had weak opioids like 
codeine.  About
40 percent in Africa, 35 percent in Latin America and 25 percent in
Asia had irregular shortages of morphine or its equivalents.      The report 
was prepared by Help the Hospices, a British charity that trains hospice 
workers and supports hospices in poor countries, for World Hospice and 
Palliative Care Day, last Saturday. <!--
D(["mb","\u003c/strong\u003e\u003c/div\u003e  
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color\u003d\"#0000ff\"\u003e\u003c/font\u003e\u003c/strong\u003e \u003c/div\u003e
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color\u003d\"#0000ff\"\u003eThree hundred questionnaires were sent to 
all the hospices and end-of-life specialists in poor countries that the 
researchers could find. Only 69 were returned, so the results cannot be 
regarded as scientific, but they do show what obstacles 
exist.\u003c/font\u003e\u003c/strong\u003e\u003c/div\u003e  
\u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e\u003c/font\u003e\u003c/strong\u003e \u003c/div\u003e
  \u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003eThe chief reasons respondents gave for 
the shortages were restrictive national drug laws, fear of addiction, 
broken-down health care systems and lack of knowledge by doctors, patients and 
policy makers.\u003c/font\u003e\u003c/strong\u003e\u003c/div\u003e  
\u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e\u003c/font\u003e\u003c/strong\u003e \u003c/div\u003e
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color\u003d\"#0000ff\"\u003eRespondents described individual problems 
in their countries. In Honduras and Malawi, patients could get no more than a 
three-day supply. In the Philippines, a doctor needed two licenses to prescribe 
morphine. \u003c/font\u003e\u003c/strong\u003e\u003c/div\u003e  
\u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e\u003c/font\u003e\u003c/strong\u003e \u003c/div\u003e
  \u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003eIn individual comments, respondents 
detailed their complaints.\u003c/font\u003e\u003c/strong\u003e\u003c/div\u003e  
\u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e“Drug companies are 
not willing to import oral morphine solution as they will not make enough 
profit due to spending months on legal papers,” a doctor in Ecuador 
wrote.\u003c/font\u003e\u003c/strong\u003e\u003c/div\u003e  
\u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e\u003c/font\u003e\u003c/strong\u003e \u003c/div\u003e
  \u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e“It is simply irrational that oral 
morphine is not available in the country whereas expensive fentanyl patches can 
be made available for the rich patients,” wrote a doctor in 
Bangladesh.\u003c/font\u003e\u003c/strong\u003e\u003c/div\u003e  
\u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e\u003c/font\u003e\u003c/strong\u003e \u003c/div\u003e
  \u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003eDr. Willem Scholten, the 
\u003c/font\u003e\u003c/strong\u003e\u003ca title\u003d\"More articles 
about 
World Health Organization\" 
href\u003d\"http://topics.nytimes.com/top/reference/timestopics/organizations/w/world_health_organization/index.html?inline\u003dnyt-org\"
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top.js.OpenExtLink(window,event,this)\"\u003e",1]
);

//-->     Three
hundred questionnaires were sent to all the hospices and end-of-life
specialists in poor countries that the researchers could find. Only 69
were returned, so the results cannot be regarded as scientific, but
they do show what obstacles exist.     The
chief reasons respondents gave for the shortages were restrictive
national drug laws, fear of addiction, broken-down health care systems
and lack of knowledge by doctors, patients and policy makers.     Respondents
described individual problems in their countries. In Honduras and
Malawi, patients could get no more than a three-day supply. In the
Philippines, a doctor needed two licenses to prescribe morphine.      In 
individual comments, respondents detailed their complaints.  “Drug
companies are not willing to import oral morphine solution as they will
not make enough profit due to spending months on legal papers,” a
doctor in Ecuador wrote.     “It
is simply irrational that oral morphine is not available in the country
whereas expensive fentanyl patches can be made available for the rich
patients,” wrote a doctor in Bangladesh.     Dr. Willem Scholten, the <!--
D(["mb","\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003eWorld Health 
Organization\u003c/font\u003e\u003c/strong\u003e\u003c/a\u003e\u003cstrong\u003e\u003cfont
 color\u003d\"#0000ff\"\u003e official in charge of advocating 
greater access to painkillers around the world, said his impression was that 
“the situation is even worse than that found by the 
survey.”\u003c/font\u003e\u003c/strong\u003e\u003c/div\u003e  
\u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e\u003c/font\u003e\u003c/strong\u003e \u003c/div\u003e
  \u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e“Only 10 or 15 countries have a 
reasonable per capita consumption,” he said. The gap between them and the rest 
of the world — about 175 countries — is “very 
wide.”\u003c/font\u003e\u003c/strong\u003e\u003c/div\u003e  
\u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e\u003c/font\u003e\u003c/strong\u003e \u003c/div\u003e
  \u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003eFear of addiction, he argued, creates 
shortages that hurt more people than strict laws 
protect.\u003c/font\u003e\u003c/strong\u003e\u003c/div\u003e  
\u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e\u003c/font\u003e\u003c/strong\u003e \u003c/div\u003e
 \n \u003cdiv\u003e\u003cstrong\u003e\u003cfont 
color\u003d\"#0000ff\"\u003e“Globally,” he said, “several hundreds of 
millions of people will require analgesia at least once in their lifetimes, 
while only a small fraction of this number misuses 
opioid.\u003c/font\u003e\u003c/strong\u003e\u003c/div\u003e\u003cbr\u003e\u003cbr\u003e\u003cdiv\u003e\u003cfont
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//-->World Health Organization
official in charge of advocating greater access to painkillers around
the world, said his impression was that “the situation is even worse
than that found by the survey.”     “Only
10 or 15 countries have a reasonable per capita consumption,” he said.
The gap between them and the rest of the world — about 175 countries —
is “very wide.”     Fear of addiction, he argued, creates shortages that hurt 
more people than strict laws protect.    
 “Globally,”
he said, “several hundreds of millions of people will require analgesia
at least once in their lifetimes, while only a small fraction of this
number misuses opioid.Group [EMAIL PROTECTED] [EMAIL 
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