The severe restrictions imposed by drug control authorities and the Narcotics Bureau regarding trading of morphine has resulted in a severe shortage of morphine tablets, essential for pain management of terminally ill cancer patients in Mumbai and Maharashtra.
According Dr. D.K. Baheti, chief of pain management clinic at the Bombay Hospital, only one-forth of the total demand of the drug is currently met in the Mumbai hospitals.
A terminally ill person requires 100 mg of morphine in a day. Therefore 50,000 mg morphine is required on a daily basis to treat 500 terminally ill cancer patients in the city, he said.
"The city is getting supply of only 12,500 mg morphine which is just enough to meet one-fourth of the total requirement," he said. Whereas, the number of cancer patients is increasing amid shrinking supply.
Cipla, Modi Mundi Pharma, and West Coast Pharma are some of the major suppliers of morphine to the city and state-based hospitals. Most of these companies supply morphine even to institutions like WHO. "We manufacture morphine only for providing service as there is nil profit here," said a senior marketing official at Modi Mundi Pharma.
Strict restrictions amid intricate formalities are required to be adopted by the morphine manufacturers. "The procedures include a lot of paperwork with tight scrutiny, numerous licenses, maintenance of records etc. Even a small fault at any point of time could lead the manufacturer to jail," said the Modi Mundi official. Besides restrictions, low profit margin and less penetration of the drug has made the companies to restrict the manufacture of morphine.
Apart from short supply, the availability of morphine only at few centres is another problem. Morphine could be stocked only at few centres like Bombay Hospital, Tata Hospital, Jaslok Hospital, and Hinduja Hospital. "Even a big hospital like the Bombay Hospital is not being able meet its monthly demand of 30-40 gm per month," he said.
Nevertheless, some hospitals hold the policy of not giving morphine to a person without their own doctors' prescription.
The non-availability of morphine at an optimum scale has led the doctors to look at some other alternatives like Phentanyl Patch, marketed by MNC Janssen Cilag. The patch costs Rs. 400 per 25 micro-gram and lasts for three days. "Morphine only costs about Rs 2 for one day treatment. Besides, it is more effective compared to Phentanyl," he said.
The situation in rest of the state is more terrible. Apart from Mumbai, Morphine would be available only in few cities like Pune, Aurangabad and, Solapur. "In Maharashtra, the demand supply ratio would be as extreme as 8:1," he said.