Millions of children and adults around the world, afflicted with terminal or life-threatening illnesses, suffer from severe physical pain, screaming out and begging for help. There is an effective treatment available that is easy and cheap to produce. And yet, for various reasons, including government regulations based on disproportionate concerns about misuse, and a historical neglect of suffering even within medical systems, most people are unable to access this treatment. 

The lack of access to morphine and similar opioids is a reality specific to most low- and middle-income countries, and it is a critical issue from an ethical, human rights, medical and humanitarian perspective. It is urgent to effect rapid change through effective, compassionate, evidence-based policies. Every delay means more people suffering needlessly.

While each country has its own specific issues and bottlenecks, policymakers can make real progress in solving the problem by implementing some basic principles and measures, based on successes achieved in other parts of the world.

There are remarkable individuals who have taken the initiative, overcoming bureaucracy and facilitating access to morphine and palliative care in specific regions and countries. So much more could be achieved, and more quickly, if central health authorities made this a top priority, loosened regulatory hurdles, ensured widespread training and education on palliative care, and facilitated the procurement, production, distribution and prescription of oral morphine. Dr. Faith Mwangi-Powell, founding Executive Director of the African Palliative Care Association, has said that the success story of Uganda shows what’s possible when different groups come together, but that the “most important thing is good political will.”

This short guide summarises some of the key issues and solutions, including an emphasis on the fundamental ethical principles from which all else flows. The many organisations working on the subject of pain relief have developed country-specific recommendations and solutions through painstaking work on the ground. This guide offers an additional voice in support of these efforts.