Wednesday, January 15, 2014

Untreated Cancer Pain a ‘Scandal of Global Proportions’, Survey Shows

I wrote this article for the Independent, a local English daily newspaper, it is going to be published on Jan 20 in a special health magazine they publish weekly, called The Stethoscope.  I am trying to raise the profile of this issue in Bangladesh as it affects most of my patients.

Untreated Cancer Pain a ‘Scandal of Global Proportions’, Survey Shows

When a child develops leukemia, cancer cells invade the bone marrow, multiplying so rapidly that this space inside the bone becomes completely full of cells, pressing powerfully against the surrounding bone. This is extremely painful. If this child happens to live in Bangladesh, it is likely that he or she will not have access to any pain medications stronger than paracetamol. This is despite the fact that effective stronger pain medicines are available at a relatively low cost. This is not just a problem in Bangladesh. Globally, more than 5 billion people live in countries where access to these medications is extremely limited or not available at all.

The recent ground-breaking results of the Global Opioid Policy Initiative (GOPI) found that in most countries, multiple barriers prevent the routine use of inexpensive and effective opioid pain medications, such as morphine. "When one considers that effective treatments are cheap and available, untreated cancer pain and its horrendous consequences for patients and their families is a scandal of global proportions," say Nathan Cherny lead author of the report. Pain relief is widely accepted as a patient right and a human right, and the World Health Organization (WHO) has called for the integration of pain relief into the care of all people with cancer.

Although it is important to take precautions to prevent misuse of opioids, many developing countries, including Bangladesh, have extremely strict opioid control policies. This limits the availability of opioids for legitimate use. Currently low and middle income countries account for only 7% of global opioid consumption despite having 80% of the world’s population. “The reality is that most of the world’s population lacks the necessary access to opioids for cancer pain management” Cherny says.

The WHO Model List of Essential Medicines, recommends 7 essential opioids be available in all countries. In Bangladesh only 3 of these medications are on the national formulary and none are actually available more than half of the time.  Over-regulation further limits the supply of opioids in Bangladesh, as only cancer specialists and surgeons are allowed to prescribe opioids.

Due to public misperceptions that opioids should only be used in patients who are dying, many people with pain are unaware that they may benefit from these medications. Doctors often lack training on how to safely prescribe opioids and may be afraid to do so, especially for children. Adequate training and education are essential to improving the ability of doctors to manage pain appropriately.

What are the next steps as we move forward?  No single solution will be appropriate for all countries. The solutions must be adapted to the local context. We can learn from developing countries where significant progress has been made, including: Uganda, Vietnam, and Nepal. In each of these countries, an essential early step was reform of national drug control and public health policies that were preventing medical access to opioids. Ensuring that pain relief policies are developed as part of the National Cancer Control Plan is also an important step. Lastly, civil society and health advocates must work to engage the general public to create a movement for change. 


  1. Fantastic article Megan! Keep up the great work! I cannot think of a better advocate for such an essential and widespread issue!

  2. megan - i was hoping to gain some insight from you about a mutual patient (someone you saw in dhaka who has just moved to the USA and i am now treating). would it be possible to contact you via email? feel free to contact me at my work email - (i am a pediatrician in North Carolina. you can visit my practice's webpage at