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The powerful painkiller opioid is not made in Ethiopia and shortages of imported medicines are rampant, it has disappeared from pharmacy shelves. Morphine is traded on the black market, but very few can afford the sky-high prices it fetches. In Ethiopia, a new initiative has begun, but too late for those suffering without oral morphine.
The powerful painkiller opioid is not made in Ethiopia and shortages of imported medicines are rampant, it has disappeared from pharmacy shelves. Morphine is traded on the black market, but very few can afford the sky-high prices it fetches. In Ethiopia, a new initiative has begun, but too late for those suffering without oral morphine.
Such suffering gives a glimpse into a vast, hidden opioid crisis that is the reverse of what is happening in wealthier countries. While addiction to unregulated opioids such as fentanyl is claiming tens of thousands of lives every year in rich countries, millions more in the developing world are dying in agony for want of medication.
The poorest countries receive just 1% of the global morphine supply, despite having 50% of the world’s people, according to a report published in 2017 by the Lancet’s commission on palliative care and pain relief. In Nigeria, for example, there is only enough morphine available to meet 0.2% of needs. In Canada, by contrast, there is enough to meet more than 3,000% of national needs.
Ethiopia, Africa’s second-biggest country by population, with more than 120 million people. Last year, Hospice Ethiopia helped 280 chronically and terminally ill people in Addis Ababa. Tens of thousands more sick Ethiopians suffer with no relief at all.
The World Health Organization calls morphine “a gold standard for pain relief” and has included the opioid in its essential medicines list since 1977. It is strong, fast-acting, and easy to administer. It is also cheap. Making morphine available as part of a wider palliative care package would cost just $3 a head in poor countries, according to the Lancet. When prescribed as a drinkable syrup, it is too weak for addicts.
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Yet in many African countries, doctors are often reluctant to prescribe the drug, seeing it as addictive or dangerous. This stems from a lack of training, with palliative care rarely featuring on medical school curricula, says Dr Yoseph Mamo, one of the handfuls of Ethiopian health professionals with palliative care expertise.
Things are slowly changing. Taking the lead from Uganda’s innovative approach, which focuses on free access to morphine, several African countries including Rwanda, Malawi, and South Africa have integrated palliative care into their health systems. Ethiopia has more work to do but has developed national guidelines for palliative care, and a plan to produce morphine locally is in the pipeline.
