Page 0063

CANCER MANAGEMENT

CANCER CONTROL 2015 61

with notifications regarding the rules to be followed by the

state governments. It is up to palliative care activists and

state governments to ensure that the amended rules are

implemented.

If we take morphine consumption in the country as the

index of access to palliative care, there has been little

progress in last few years as can be seen in Figure 1 (15).

Considering that the official reporting of data to INCB has

been erratic until recently, this graph has used the officially

communicated record of the quantity of morphine sold by

the Government opium and alkaloid factory to

manufacturers of formulations of morphine. Considering

that morphine is the only oral opioid belonging to step III of

the WHO analgesic ladder, these figures are likely to be

representative, with some exceptions. In 2000, the peak was

caused by a large scale purchase of morphine by the

Government of India using funds from World Health

Organization for free distribution to Regional Cancer

Centres. We know for a fact that the bulk of it was never

used and was eventually destroyed after expiry date. The

drop in consumption from 2002 to 2006 was caused by a

breakdown in the Government Opium and Alkaloid Factory,

following which production of morphine was reduced.

Summary

There has been a lot of progress in palliative care in India,

but the fact remains that despite the passing of almost a

quarter of a century of palliative care activity in the country,

even today palliative care reaches only about 1% of the

people in India. If we take per capita consumption of opioids

belonging to the step III of the WHO ladder as a criterion,

this has been on a plateau for many years now.

India is still at that phase when it seems poised to leap

forward, though the dynamism is yet to be manifest, in the

following three areas:

‰ The NDPS Amendment Act is simplified now, but needs

to be implemented by state governments. Nongovernment

palliative care organizations, who already

are struggling with paucity of resources, will have to take

on the onerous task of finding funds and personnel for

catalyzing government action, state by state, through 29

states and six union territories.

‰ Despite a submission before the Supreme Court of India

expressing willingness to incorporate palliative care in

undergraduate curricula, and despite the palliative care

community preparing the curricula and giving a

framework for implementation, the Medical Council of

India and the Indian Nursing Council are yet to act on

the matter.

‰ Though the National Program in Palliative Care was

created in 2012, due to lack of budget allocation, only a

tiny part of the programme has been implemented. Even

for the part that is funded, considerable catalytic work is

needed with the state governments to ensure that

proper plans are made and implemented.

In short, some major barriers to access to palliative care in

India have been overcome, but implementation of created

policies and laws still requires massive efforts by both the

government system and non-government organizations. The

non-government organizations do have the commitment but

would need international support to effectively facilitate

45.74

116.10

261.00

178.11

75.10

109.40

84.00

121.11

73.10

264.67

237.50

259.24

223.50

251.75

272.25

291.00

278.00

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Morphine in KG

350.00

300.00

250.00

200.00

150.00

100.00

50.0

0

Year

Figure 1: Consumption of morphine, 1998-2014

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