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Prisoners of Pain

Whereas the quantity of available opioids in the United States is more than three times what patients in need of palliative care require, in India, the supply is just 4% of the required quantity, and just 0.2% in Nigeria. The reason is a misplaced fear that clinical use of opioids will fuel addiction and crime in the community.

PRINCETON – Last month, an Egyptian court sentenced Laura Plummer, a 33-year old English shop worker, to three years in prison for smuggling 320 doses of tramadol into the country. Tramadol is a prescription opioid available in the United Kingdom for pain relief. It is banned in Egypt, where it is widely abused. Plummer said that she was taking the drug to her Egyptian boyfriend, who suffers from chronic pain, and that she did not know she was breaking Egyptian law.

The UK media have been full of sympathetic stories about Plummer’s plight, despite the fact that she was carrying a quantity in excess of that for which a UK doctor can write a prescription. Whatever the rights and wrongs of Plummer’s conviction and sentence, however, the case illuminates an issue with much wider ramifications.

Last October, the Lancet Commission on Palliative Care and Pain Relief issued an impressive 64-page report arguing that relieving severe pain is a “global health and equity imperative.” The Commission is not the first to make such a claim, but its report brings together an abundance of evidence to demonstrate the seriousness of the problem. Each year 25.5 million people die in agony for lack of morphine or a similarly strong painkiller. Only 14% of the 40 million people requiring palliative care receive it.

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