Cheap and effective opioid painkillers like morphine are usually not available for patients receiving cancer treatment and end-of-life care in Pakistan. Why is the medication hard to come by?
00:01Once a soldier in Pakistan's army, Sher Afzal is now fighting a losing battle.
00:10He is dying of kidney cancer and has come to this hospital in Peshawar in search of pain relief.
00:18But in the country he fought to protect, it's almost impossible to get morphine.
00:23Dr Awais Naeem, the chair of medicine at this hospital, says that across Pakistan, morphine is in short supply.
00:33We do not have morphine in government setups and they are not in the stock supply, they are not in the policy as such to be supplied.
00:40So what we are left with are limited options. As per WHO ladder, we try to follow that with what we have available.
00:47Instead of morphine, patients here are given less effective substitutes.
00:50Meera Hassan has terminal prostate cancer and has suffered from a stroke.
00:58He is in so much discomfort that he struggles to even speak.
01:03The doctors give him what pain relief they can.
01:11More than 125,000 people die of cancer in Pakistan each year.
01:18I can do best whatever is available as per rules and regulations.
01:25If my country passes a law that someone has to die in pain, then I have to live with it.
01:31I am not a lawmaker, I am not a regulatory authority.
01:34While healthcare practitioners like Dr Naeem must work within strict limits,
01:39some families take matters into their own hands.
01:41One of those families is Masood's.
01:45Masood's uncle has stage 4 bone cancer and he tells us that his cancer has progressed so much that he can barely move.
01:54His entire body is in debilitating pain.
01:57I am not a lawmaker, I am not a lawmaker, I am not a lawmaker, I am not a lawmaker, I am not a lawmaker.
02:10After trying to find a hospital or pharmacy across Pakistan that provides morphine, DW found one private facility in the capital where it is available.
02:20But even their supplies aren't continuous.
02:24Dr Akhtaz Kazi, who is a palliative care consultant, says that last year there were three months when they did not have any stock because of bureaucratic policies.
02:34I have had patients who have come to me and said that if it is expensive we are willing to spend the money.
02:41And it is, it becomes a very difficult situation for me to reply to them when I say that no it's the rules, it's not in the hospital.
02:51I cannot give it to you because we have run out, because we are still waiting for the paperwork to come through.
02:55For hospitals to obtain any morphine, they have to navigate a complex multi-step process involving several government agencies.
03:06In the capital Islamabad, for example, hospitals must apply to the Drug Regulatory Authority of Pakistan, also known as DRAP.
03:16And after an inspection, DRAP then sends the request to the Ministry of Narcotics Control for final approval.
03:22The entire process can take months, leaving hospitals without morphine when it's most needed.
03:30This all standard operating procedure and SOPs are ever evolving.
03:35So being the government department and responsible for the availability to ensure that now we are again working with our counterparts, that how can we further improve it?
03:44Dr Abedullah told DW that the heart of the issue is the fear that increased access to opioid painkillers will lead to substance abuse.
03:56Record keeping for all these medicines are very important to avoid any potential of abuse, any potential of diversification to some other material.
04:06But until Pakistani authorities reform the current process, patients in need of painkillers are left to suffer.
04:16This family in Raupindi is also affected by the restrictive laws and regulations for morphine.
04:24Daim is only 14 years old and has terminal cancer.
04:29He can no longer walk and he needs help just to sit up.
04:33Daim's uncle says he would do anything to ease his suffering.
04:37We have sent him to save our children for every human being.
04:40We have sent him a little more.
04:41We sent him a little more.
04:42The brother's house.
04:43His brother has a small car.
04:46He has a little car.
04:47He is also a car.
04:48The one of his brother has also had a big deal.
04:50I have already told him that this is a child that we have a child that we have a child.
04:55Our entire goal of seeing to protect each other from the situation.
04:58But doctors have told us that they have never said that your child will be fine but the doctor doesn't say that we have a child.
05:01They didn't say that your child will be fine.
05:07They say that your child is going away from you every day.
05:14My son is a disease.
05:16He has been a disease for one year.
05:19He has also given me a problem.
05:22So, God gives him a health.
05:25I am in relief.
05:27Dine's family says it's likely he'll need morphine soon as his disease progresses.
05:33But the question is, will he even be able to access it?
