Push for access to morphine
Government health bosses are pushing for easier and wider access to painkilling morphine for terminally ill patients.
|||Durban - Government health bosses are pushing for easier and wider access to painkilling morphine for terminally ill patients in South Africa.
This emerged in Durban last week at a Hospice Palliative Care Association (HPCA) conference where Health Minister Dr Aaron Motsoaledi said on the sidelines that he wanted to change the law to enable morphine to be more easily administered.
He said it was wrong that patients should wish for death to alleviate their pain.
He has the support of KwaZulu-Natal MEC, Dr Sibongiseni Dhlomo, an expert in palliative care, who said nurses needed the authority to administer the drug.
However others involved in end-stage care cautioned against depriving patients of their right to choose how they want to be treated at the end of their life.
In South Africa, morphine prescription is regulated by Section 56 of the Nursing Act (33 of 2005) and only doctors and pharmacists can prescribe the drug, according to provincial health HOD, Dr Sifiso Mtshali.
However, the act has special provisions that allow certain nurses, such as midwives, to prescribe some pain medication.
“It is estimated that 99% of deaths with untreated pain, from cancer and HIV, are in low and middle income countries and 80% of the world lives in countries with low or no access to medication for severe to moderate pain,” Motsoaledi said.
Instead the figures showed that in 2003, six developed countries accounted for 79% of global morphine consumption, while developing countries accounted for just 6%.
In South Africa the total morphine consumption in 2005 was 1.96mg per capita, including the private sector.
“This is against the estimated need of 26mg per capita. It is clear that we need to change our systems and perhaps even our regulations so that morphine can become more accessible,” he said.
“There are also proposals (from the conference) on how to ensure that patients who need pain control can access help.”
This meant that the issue of access to morphine was critical.
“We do need, in our palliative care policy which we are busy formulating, to outline how we will make access to morphine easier while ensuring that it is not abused,” Motsoaledi said.
He said nurses working in palliative care should be able to administer the Schedule 6 substance to patients with chronic and terminal illnesses at home and in hospices.
“Access to the drug by palliative care practitioners will only bring dignity to our people who have lost hope in life; people who would have otherwise applied for assisted suicide.
Dhlomo said he was aware that nurses in Uganda were empowered to administer morphine.
“As South Africa we need to have a dialogue to establish why our nurses cannot do the same here. If it is working very well in a country with limited resources like Uganda, I really don’t see why it can’t work here. We should in the same approach recognise that the practice of palliative care in our country will be augmented by realising that we need to empower professional nurses to be able to dispense and administer morphine as Uganda has been doing for years,” he said.
Dr Joey Gouws, the registrar of medicines at the Medicines Control Council (MCC), said morphine was highly controlled and no nurse could be allowed to handle the drug without proper training.
“Paramedics administer morphine because applications and presentations were done, with the MCC. The MEC, if he wants nurses to administer the drug, all proper channels will have to be followed. The Nursing Council will have to make presentations as to why the nurses needed to handle the drug.”
Professor Sean Davison, executive committee member of Dying with Dignity, who is known for helping his terminally ill mother end her life, said giving morphine to the terminally ill was a good idea but stressed that people should always be given the space to make decisions.
“For some patients, this would not be an answer to their pain. An example is the late IFP MP, Mario Oriani-Ambrosini, who made a different choice in dealing with pain. He could have taken morphine but he didn’t,” Davison said.
Ambrosini took his life after battling with terminal lung cancer, having rejected chemotherapy as a treatment option.
Dr Liz Gwyther, HPCA chief executive and an opponent of assisted suicide, said pain management was the key to caring for chronic condition patients.
However, strict controls from the International Narcotics Control Board and local health regulations made it difficult for patients to access it.
“We are proposing that nurses with training in pain management can prescribe morphine,” she said.
Daily News