Harmala Gupta, Founder-President, CanSupport, New Delhi, India
Palliative care is looking up in India. We are on the verge of passing an historic bill in parliament that will widen access to oral morphine by simplifying the current licensing procedures. Registered medical institutions will be able to help those who until now had little other recourse than to beg for an early end to their misery.
I recall making a visit with our CanSupport home care team when we did not have a licence for oral morphine. Exhausted, the family were on a constant 24-hour vigil to prevent their loved one from jumping off the roof as he could no longer bear his pain. It is hoped that with the passage of the amended NDPS Bill (Narcotic Drugs and Psychotropic Substances) such tragic stories will be a thing of the past.
It has taken almost two decades to amend this bill and to bring it to parliament. It is the culmination of the combined efforts of a number of dogged individuals and institutions working in palliative care in India and abroad. There are many who have also played their part by sharing their stories of pain and suffering. Sumita had looked into my eyes and made me promise that no one would suffer the way she had, travelling long distances and spending hours sitting on a hospital bench in excruciating pain to get oral morphine: “Bring it to our homes,” she begged.
The pharmaceutical industry is perturbed that a clause inserted in the amended bill to protect them from unnecessary harassment has been dropped on the advice of the Law Ministry. This clause sought to temper punishment for “inadvertent” errors by reducing it from a jail sentence to a monetary fine.
There is also an apprehension that when the demand for oral morphine rises we shall be unable to meet it. This is because the present methods for growing the poppy plant, extracting its gum, and processing it in government factories, are all outdated. Recognising this, the Revenue Department which, for historical reasons, still controls opium production, asked private pharmaceutical companies to apply for the right to produce oral morphine. It was hoped that this would introduce more effective production techniques that would in turn increase the amount of morphine powder, which at present is 250 kilograms. This may look like a large amount given the present miniscule use of oral morphine, but come easier regulation, more training in the use of oral morphine and further growth of palliative care units, we could be facing a situation of acute scarcity.
To conclude, even as we justifiably toast our success in amending the NDPS Bill, which we hope will be passed in this session of parliament, we must also prepare for its consequences.
To find out more …
- The website of the The Indian Association of Palliative Care includes stories about palliative care in India, other useful links and resources and a directory of services.
- CanSupport, founded by Harmala Gupta in 1996, is the largest home-based palliative care programme in India. Click here for more information.
Join us in Prague…
If you’ve enjoyed this post, you can hear more about palliative care in India at the 13th World Congress of the EAPC. Harmala will be speaking on ‘Volunteers: The model of India’.
On Thursday, we’ll be publishing another story from India when a sixth-form student from the UK visits Kerala for a life-changing experience.