Unavailability of morphine tablets, the gold standard drug used to relieve pain, has increased the patients' suffering.
Morphine is used by cancer patients as a pain reliever. The patients who undergo surgery also need this drug. But as it is a narcotic drug, its manufacturing and marketing is too troublesome in the country, resulting in unavailability of this key drug often.
"I went from one market to another to buy morphine tablets as per doctors' advice for my son who is suffering from tremendous pain in his lower abdomen, but to no avail. Finally, I had to buy morphine injection paying five times more than the price of tablet," said the mother of Motalib, a 13-year-old boy who is suffering from rectum cancer.
"Motalib was admitted to Bangabandhu Sheikh Mujib Medical University Hospital with rectum carcinoma and after seven months, the boy could get to sleep after receiving morphine injection," said Prof Nezamuddin, project coordinator of Palliative Care Unit of the university.
He also said that morphine is not addictive for the cancer patients with severe pain. Rather, it is one of the most effective drugs to relive their pain without much side-effects. The duration of action of the oral morphine is three times more than that of the injection. So, the physicians prefer oral morphine for the patients.
Although there are more than 250 pharmaceutical companies in the country, only Gonoshasthya Pharmaceuticals manufacture morphine tablets, as manufacturing and marketing of this drug is quite troublesome due to excessive control by the Directorate of Narcotics Control.
To manufacture narcotic drugs, a company needs a licence to import raw materials, then it needs to take permission every time it imports the raw materials and it also has to collect no objection certificate from the directorate for customs clearance.
The company also needs to go through verification before using the raw materials for production, inform the directorate before and after production, send the drugs to the chemical laboratories for quality testing and then have to collect permission for sale after getting the chemical reports, said narcotics directorate sources.
The pharmacies that sell these drugs also have to go through such troublesome process that often discourage them to sell these drugs, they added.
"As the narcotic drugs can be used as addictive substance, the government has imposed strict control over manufacturing, marketing and use of the drugs," said Abu Taleb, additional director of the Directorate of Narcotics Control.
While visiting some drug stores, this correspondent found that most of the pharmacies have licences to sell morphine injection, not tablets. One morphine tablet costs Tk 10 and the injection costs Tk 20, but the patients have to pay Tk 30 to 50 for the injection.
"The company has not been supplying the tablet for the last six months. So, the patients are returning without tablets," said Shamsul Haque, a salesman of Messrs Oushadhalaya at Aziz Supar Market, Shahbagh.
When contacted, Kazi Mansur Rahman, assistant manager, marketing of Gonoshasthya Pharmaceuticals, said there is no reason for not supplying morphine tablets as they still have a stock of 1,25,000 tablets.
"We can't supply the drugs if the pharmacies with licences does not come again with a permission from the Directorate of Narcotics Control for a new supply," he said, adding that they have urged the government several times to provide licences to more pharmacies to sell morphine tablet, but to no avail.
Although global consumption of morphine had begun to increase significantly in the mid 1980s, especially in the developed countries, the developing countries use small amounts of morphine or none at all, experts said, adding that the World Health Organisation also recommended the governments to ensure availability of low cost morphine for oral administration.