Is the War on Drugs Leaving Many People With Chronic Pain Without Relief?

A CBS News Video explores the limited access to pain medications of people in more than 80% of the world, who only have access to 5% of world morphine.  For people in countries such as Uganda, this means that AIDS and cancer patients, who are suffering from terrible, long-term pain, will be unable to gain access to pain medication.  Diederik Lohman, the senior researcher with Human Rights Watch, has drawn a parallel between torture and global pain, stating that it is no less a violation of human rights to deny (or to not supply) a suffering cancer patient or burn victim with pain medication, than it is to torture a person.  Furthermore, he has gone on to say that while a torture victim has the opportunity to sign a confession and cease the torture, “the patient with pain does not have that option.”

While one may be quick to assume that the reason for a lack of access to pain medication comes from unavailability or lack of resources, this is not the case.  Morphine is, in fact, very cheap and easy to acquire.  The problem is more complicated, and has arisen as a side-effect of the war on drugs.  As the market for drugs (such as heroin, a morphine derivative) has expanded tremendously, the war on drugs has led many countries to instill new and rigid regulations on controlled substances, thus leading to a reduction of the availability of the same controlled substances for medicinal purposes. 

 This is especially a problem in countries such as Uganda, where there are very few doctors who are trained in the dosing and administration of morphine.  However, currently new protocols are in the works aiming to extend the laws to allow and train nurses to administer controlled pain medication.

 Unfortunately, the inevitability of collateral damage will always render us as having to choose the lesser of the two evils.  Especially when the topic revolves around allowing access to medication, the risk of a black market and drug abuse will continue to stifle availability.

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3 comments
  1. I wonder if we need be so pessimistic. Even in Uganda, as you point out, nurses are being trained to administer pain relief because there are not enough doctors who can do it. Does this show some kind of willingness to overcome the effects of the narcotics laws? What sort of changes could expand access to morphine or other suitable analgesics for severe pain? How would you foresee approaching this human rights problem?

  2. aakselrod said:

    I may have understated the efforts being made currently to mitigate the situation; indeed, training nurses to administer pain medication has been very effective. Hopefully, countries like Uganda will be able to proliferate this practice, to allow for people who are not able to come to a hospital or clinic to also receive medication. That, however, may be more difficult, as it is often hard to keep track of people who are unable to follow up with health professionals. Perhaps, it will be easier to acquire permission to distribute more morphine if a better infrastructure was created and more workers were trained to distribute it.

  3. When it comes to human rights and access to healthcare and medicine there seems to constantly be a need for a fine balance to be met. Alla’s post addresses the balance between ensuring that people who are suffering intense pain find relief while not at the same time stimulating an illegal drug market that will intensify drug wars. We have also discussed in class the balance between protecting and encouraging the progress in the creation of new drugs while also trying to ensure access to these medications. Yet another balance in this area that I came across while taking the Citti IRB training for doing research with human research subjects is that of clinical trials and children. Can true informed consent ever be given from children? Without informed consent research has been deemed unethical, but at the same time research and clinical trials must be done on children for the good and health of all children.
    I wonder if in the agreements about these balances that have to be met, if there is ever one right answer or if the answer will always have to change from situation to situation. It seems as though in answering these questions every example can be met with a counter example. A story quite opposite from Uganda’s lack of access to pain relievers for those who need them and will benefit appropriately from them is that of Iran and Afghanistan. Much conflict in Afghanistan is do to the drug trade of opium and much of Iran’s youth are becoming addicted to opiates by their thirties. Below is a statement about Iran’s youth and drug use from the United State’s Institute for Peace. The website is http://iranprimer.usip.org/resource/youth

    “Drugs: Use of narcotics has become a serious problem among youth. Opium has been used for centuries in Iran, and cultivation of opium poppy was a large part of Persia’s gross national product in the 19th century, before oil, according to the U.N. Office on Drugs and Crime. It was outlawed in 1955. But drug use and the variety of drugs used began to grow again after the 1979 revolution, particularly among youth and women.
    Statistics vary widely. In 2010, the Islamic Republic had some 1.2 million hardcore drug addicts, with another 800,000 casual users, according to the head of Iran’s drug prevention program. The average age for users was in their twenties. Another 130,000 become addicted to drugs annually, according to Iran’s police chief. But the U.N. 2010 World Drug Report reported that Iran had one of the world’s highest rates of heroin addiction, with some 20 percent of the population aged 15 to 60 involved in illicit drug use, and up to 16 percent in that age group injecting drugs. Iran also consumed the largest amount of the opium not converted into heroin – a staggering 42 percent of the world total. Proximity to Afghanistan facilitated the trend. From 1996 to 2008, Iran accounted for more than two-thirds of all global opium seizures, much of it from across the 600-mile border with Afghanistan, the U.N. report said.”

    An interesting yet very lengthy New York Times article about the situation of drugs and conflict in Afghanistan in 2008 can be found at http://www.nytimes.com/2008/07/27/magazine/27AFGHAN-t.html?_r=1&ref=opium

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