Sub: Seeking your valuable support for improving access to pain relief; through high priority listing of the NDPS Amendment Bill during this budget session
Dear Secretary General, RajyaSabha
“The de facto denial of access to pain relief, if it causes severe pain and suffering, constitutes cruel, inhuman or degrading treatment or punishment.” UN Special Rapporteur on Torture[1]
In India, people with advanced incurable disease are unimaginably miserable. Their financial resources are usually exhausted due to expensive curative treatment, many are homeless and in debt. Unrelieved pain, vomiting, breathlessness and other health problems are part of their daily existence.
As India’s health system rapidly changes, evidence suggests that this development – across both public and private sectors – focuses disproportionately on curative services[2]. However, once an illness is declared incurable, the health system is ill equipped to address this suffering. Evidence further shows that gaps in the Indian health care system and lack of access to health services disproportionately affects the poor and disadvantaged populations[3]. Unfortunately, experts estimate that in India only a tiny minority of those who need palliative care receive it.
Palliative care improves the quality of life of people with advanced life threatening or debilitating illness by providing relief from pain and other physical symptoms and care for psychosocial needs. If cure is possible, palliative care provides essential supportive care to provide pain relief and minimize suffering. In fact, recent research shows that early palliative care with standard cancer treatment extended survival as compared to cancer treatment alone[4].
The commonest symptom of people with such diseases is pain. Pain can be excruciating, often occupying every moment of the person’s life. Most pain can be relieved with application of the WHO pain ladder at low cost. Most major medical institutions have no effective pain relief or palliative care services. Even today the majority of Regional Cancer Centres have no oral morphine, which, according to the Government of India’s list is an “Essential Medicine”.
One of the biggest barriers to pain relief is the Draconian Narcotic Drugs and Psychotropic Substances (NDPS) act. Recognizing this, the Department of Revenue of Government of India has drafted an amendment, which would still include restrictions that are necessary to prevent abuse of morphine, but would remove the needlessly complicated provisions of the act. This would be a great step, that could directly result in great reduction in the burden of suffering in the country. I understand that on the 18th of April 2013, the Union Cabinet approved of the amendment and that it is being placed before the Parliament.
I seek your help to ensure that the NDPS Amendment Bill does not get lost in the mass of items that would come before the Parliament for consideration during this budget session.
Please help our people in pain by ensuring high priority listing of the NDPS amendment Bill.
Yours sincerely
[1]Manfred Nowak, UN Special Rapporteur on Torture, Cruel, Inhuman or Degrading Treatment or Punishment. August 2009
[2]Balarajan, Y, Selvaraj, S., Subramanian, S.V. Health Care and Equity in India. The Lancet. 2011: 377; 505-515.
[3]Ibid
[4]Temel, JS, Greer JA, et al. Early Palliative Care for Patients with Metastatic Non-Small Cell Lung Cancer. NEJM 2010; 363:733-742.