Discussion of All Things Political

For much of the Western world, physical pain ends with a simple pill. Yet more than half the world's countries have little to no access to morphine, the gold standard for treating medical pain.

Freedom from Pain shines a light on this under-reported story. "For a victim of police torture, they will usually sign a confession and the torture stops," says Diederik Lohman of Human Rights Watch in the film. "For someone who has cancer pain, that torturous experience continues for weeks, and sometimes months on end."

Unlike so many global health problems, pain treatment is not about money or a lack of drugs, since morphine costs pennies per dose and is easily made. The treatment of pain is complicated by many factors, including drug laws, bureaucratic rigidity and commercial disincentives.

In India, the first stop in the film and the world's largest grower of medicinal poppy for developed countries, there are severe restrictions to the use of morphine domestically. In 27 out of 28 states in India, narcotics laws are so strict that doctors fear prescribing it, and patients literally scream for relief. Drug companies have little incentive to manufacture morphine for the domestic market because of reporting requirements and small profit margins.

In the Ukraine, the film reveals that access to pain medication is halted by outdated, Soviet-style bureaucracy, arbitrary limits on doses, and a lack of oral morphine. As a result, many patients experience prolonged bouts of untreated pain, particularly in rural areas. In the Ukraine, we learn that Artur, a former decorated KGB colonel suffering from prostate cancer, sleeps with a gun under his pillow - his only way out, should he decide his pain is too great. MORE

Millions of individuals worldwide suffer from acute or chronic painwithout adequate access to pain medication. The problem is particularly acute in the developing world, as Time Magazinechronicled last year:

Whether you will have access to pain treatment depends largely upon where you live. Africa, which has most of the world’s AIDS victims, is a painkiller wasteland. In India, more than a million cancer and AIDS sufferers die each year in extreme pain as cumbersome regulations and paperwork make it nearly impossible to get prescription painkillers. (India produces much of the world’s legal opium, yet nearly all of it is exported to Western pharmaceutical companies.)

The geography of pain relief is so skewed that the seven richest countries consume 84% of the world’s supply of legal opiates, according to the International Narcotics Control Board, an independent agency that enforces U.N. conventions. For the estimated 10 million people who are suffering from untreated pain, relief is often found only on the black market, or in death

This gaping unmet need and global inequity is becoming the subject of various calls for change, by pain experts, by cancer treatment advocates, by international organizations, and by the human rights community. As Brent Foster explains in this podcast, the reasons behind the inequitable global distribution of pain medication are complex – like many intractable global social problems that get too little attention by policymakers.

However, a significant (and solvable) aspect of the problem is simply the relationship of supply to demand: the need for analgesics like morphine far outweighs the available supply. In part, this is due to the fact that such analgesics are produced from opium, the sap of the poppy. Since the same plant extract can also be used to produce heroin, a significant amount of political effort is now being expended worldwide to actually inhibit, rather than encourage, opoid production. This fuels shortages of analgesics.MORE

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