The use of morphine to control pain in advanced cancer: an investigation of clinical usage in Bangladesh

Abstract

In 2007, 13% of all deaths worldwide were due to cancer, and of these 72% occurred in low- and middle-income countries. Opioids are essential for the successful delivery of palliative care and pain control. This paper reports data from a cross-sectional survey that aimed to investigate the use of morphine in advanced cancer in palliative care setting in Bangladesh, in order to inform clinical practice and fledgling service development. The study was a single semi-structured qualitative interview study. Cancer patients, family members and palliative care specialists (20 in total) were interviewed in two medical settings. Transcripts were transcribed verbatim, translated and cross-checked with two local interpreters. Data were imported into NVIVO 8 for coding. A coding frame was generated following line by line coding. Relational codes were established following peer review of coding units and the resulting frame. Despite having been under the pain and palliative care clinics only six out of 10 patients had received morphine. Lack of morphine availability resulted in physical suffering of patients and emotional distress of their families. Lack of availability of morphine was identified as the main barrier to pain control. International attention and collaboration with local policy makers is needed to simplify narcotic regulations and increase the availability of morphine.

Palliative Care Needs among Patients with Advanced Illnesses in Bhutan

“…However, its use may be erratic given that PC is an emerging concept where physicians may lack experience in PC and the use of opioids for patients who are dying and/or for extended periods. In areas where PC is not well developed, several barriers to prescribing morphine have been reported including availability of the drugs, limited knowledge and opiophobia among physicians, along with the in uence of patients and families [54,55]. The high demonstrated need for improved pain control highlight this as a priority area for development in new PC services in the Bhutan.…”

Physicians knowledge and attitude of opioid availability, accessibility and use in pain management in Bangladesh

“…Addiction: More physicians (89%) displayed concern about the rapid development of tolerance and addiction than physicians in other studies 13 . This concern had reflected significantly in their attitude towards opioid prescribing.…”

“…A qualitative study reported the barriers of opioids use in Bangladesh as: inadequate dosing, interrupted drug supply, legal restrictions and unavailability of immediate release morphine 13 . Opioid consumption in Bangladesh in 2012 was only 0.05 mg/capita 14 .…”

Various Aspects of Palliative Care in Bangladesh

“…To convene the huge challenge in Bangladesh, palliative care needs to be mainstreamed into the accessible healthcare scheme for a possible and sustainable public health advance [2]. In 2007, 13% of all deaths global were owed to cancer and among them 72% took place in low and middle-income countries like Bangladesh [3].…”