Cancer patients in developing countries often cannot get drugs for moderate and severe pain relief, due to the lack of access to opioid drugs. Access to cancer pain treatment needs to be eased, despite legitimate concerns about opioid abuse in some countries, says the World Health Organization (WHO).

“Nobody, cancer patients or not cancer patients, should live or die in pain in the 21st century,” Dr Etienne Krug, director of WHO’s Department for Management of Noncommunicable Diseases, said at the launch of new WHO Guidelines for management of cancer pain just ahead of World Cancer Day, which is observed today.

Among the problems faced by some 18.1 million new cancer patients every year, “one area that we don’t talk often about is the pain cancer patients experience,” said Krug, speaking at a press briefing in Geneva on 31 January. “Fifty-five percent of cancer patients undergoing cancer treatment experience pain, and for those with terminal or metastatic cancer, that goes up to 66 percent.”

Such pain has profound consequences on everyday life, he added: “It often doesn’t allow them to work anymore or go to school, have normal interactions, causes irritability … at a time where those patients need social interactions, need the support from their family or friends.”

The lack of access to pain drugs “is particularly acute in low income countries, where systems are not in place, but even in the high-income countries people are living and dying in pain,” Krug said.

For those with moderate to severe cancer pain, opioid painkillers like oral morphine are defined by the WHO Guidelines as an essential treatment. However, while oral morphine is on the WHO Model Lists of Essential Medicines, as of 2018 only 6 percent of low-income countries reported the drug was generally available in primary care facilities, even though it is relatively affordable. In contrast, 67 percent of high-income countries reported having oral morphine available, according to a press release that accompanied the guidelines release.

While opioid overuse and abuse is an acknowledged concern in some parts of the world, making such drugs available, under appropriate supervision, can help avert needless suffering by cancer victims, Krug said.

Opioid overdoses were estimated to cost nearly 50,000 lives in the United States last year, and the US epidemic has also fuelled fears in other countries of easing access to such drugs.

“There is a real fear, that is certainly justified,” Krug acknowledged, that opioid drugs “will be prescribed too easily, to people that don’t really need them. But it should not come at the expense of those that live and die in pain. We have to further develop our systems so those that need it get it, and those that don’t really need it, don’t get it,” he said.

“We need to raise awareness about the importance of addressing pain, and the damage it causes to millions and millions of people, and their families and friends. By raising the awareness, by making sure everyone has access to the knowledge that is needed, we hope the system will evolve and we will get to a level where everyone has access to treatment.” Krug said.

The WHO guidelines prescribe a “step-wise” approach for use of painkillers, with opioids an option after other forms of pain relief have failed, and strict safeguards on administration.

Image Credits: WHO.