With oral morphine solution inaccessible in districts, hundreds come to Kidwai every month 

Over 10 years after the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985, was amended in 2014 to streamline the process for medical use of oral morphine, this essential opioid pain medication for managing severe pain in cancer and palliative care, remains available only at the State-run Kidwai Memorial Institute of Oncology (KMIO) in the oral solution form. 

There is no functional access in districts and around 700 patients from all over the State come to Kidwai every month for oral morphine solution. October 11 is observed as World Hospice and Palliative Care Day.

Health care professionals and palliative care advocates express concern that the ground-level implementation of reforms under the Act has been inadequate. The lack of trained personnel, bureaucratic delays, and infrastructure gaps continue to hinder oral morphine solution availability in district hospitals. This has made it inevitable for terminally ill patients and their families to endure pain or travel long distances to Kidwai in Bengaluru, defeating the very purpose of decentralised palliative care services.

Some private hospitals and Karunashraya — that runs specialised palliative care services — provide morphine in tablet and injection forms. 

Palliative care policy 

Karnataka was among the first States in India to introduce a State Palliative Care Policy in 2015–2016. To implement it, a State Palliative Care Cell was established at Kidwai in 2017. Although the cell had initiated training programmes, awareness campaigns, and coordination of services across various districts in the first year, subsequently it has remained largely inactive.  

Yaduraj M.K., associate professor and head of the Department of Pain and Palliative Medicine at Kidwai told The Hindu that there is now a pressing need to reactivate and strengthen this Cell, enabling it to serve as a central hub for State-wide coordination, training, and policy execution. 

700 patients 

“Around 700 patients come to the institute from across the State every month for oral morphine solution. Reactivating the Cell would ensure both continuity and accountability within the existing framework of State-run oncology care,” he said. 

Pointing out that Kidwai has also been a pioneer in pain management, being one of the very few institutes in India to routinely use oral morphine solution rather than tablets for cancer pain relief, Dr. Yaduraj said, “At Kidwai, approximately 6 to 8 kg of morphine sulphate powder is used per year for the cancer pain management, which is among the highest in the country.”

“This stands as a testament to the institute’s commitment to safe, rational, and compassionate opioid use in patient care. Strengthening the State Palliative Care Cell at Kidwai would build on this strong foundation, allowing Karnataka to lead in the integrated palliative care system that ensures access to comfort, dignity, and pain relief for every patient in need,” he explained, adding that a proposal in this regard has already been submitted to the State Mission Director, National Health Mission.

Need for uniform rules

Nagesh Simha, former president of the Indian Association of Palliative Care and medical director of Karunashraya, said while the NDPS amendment has greatly eased access to opioid pain medication, there is a need for uniform rules and training of healthcare providers.

“It requires a lot of work, including sensitising and training doctors in providing pain relief and prescribing the medicine. We need uniform rules to implement the Act and the Union Health Ministry is working on a Central policy,” Dr Simha said.