I have just returned from a two week visit to India which including participating in the 19th meeting of the Indian Association of Palliative Care. It was great to meet old friends and colleagues, and to establish new friendships. I am honored to become one of three international members of the IAPC to serve on the IAPC board.
While talking about opioid consumption in India, I used footage of the documentary Freedom from Pain to bring home the issues (the first 6 minutes of the movie are about India (more later as well).
Let me share with you some facts about India in general
- Population: 1.21 billion (2011 census)
- More people live in India than USA, Indonesia, Brazil, Pakistan and Bangladesh combined
- India will overtake China as most populous nation by 2030.
- 17% of the world’s population
And some numbers as they relate to Palliative care
- 782,565 Cancer Deaths in 2009
- Opioid consumption (in 2009)
- morphine equivalents 239 kg (47% morphine)
- morphine equivalents per person: 0.199 mg/person
- morphine equivalents per cancer death: 305 mg/death (cf Germany 108,380 mg/death)
- Number of Palliative Care services in India: 700
- Number of Palliative Care services in the State of Kerala: 500
- Estimated 2% of population having some access to palliative care.
India is the world’s leading licit (legal) producer of opium (the latex obtained from the opium poppy plants), accounting for over 90% of global production. Poppy straw is another source of opioids.
Cost of 10 mg IR morphine tablet: 3.5 rupees (7 US cents)
Cost of 10 mg IR q4h for 3 days. 63 rupees (U$1.26)
Cost of 25 mcg/hr patch: 335 rupees ($S6.70)
The Morphine Manifesto calls for access to Immediate Release morphine prior to access to more expensive long acting opioids. It is a result of original collaborations with Pallium India, the International Association of Hospice and Palliative Care and the Pain and Policy Studies Group.