BY D SEBUNYA: As World Hospice and Palliative Care Day approaches, palliative care providers are anxious about the growing fear surrounding the use of oral liquid morphine as a pain management drug for end-of-life patients. The opioid is feared for its potential to become highly addictive and be easily misused, leading to dependence, overdose, and serious health risks.
From a legal standpoint, unlike the 2004 statutory instrument that permitted specially trained nurses and clinical officers to prescribe certain oral narcotics, the 2015 Narcotic Drugs and Psychotropic Substances (Control) Act only allows medical practitioners to prescribe opioids.
The law further defines a medical practitioner as someone registered under the Medical and Dental Practitioners Act, which excludes nurses. According to practitioners, this undermines efforts to improve access to controlled medicines for medical and scientific use, particularly in providing palliative care services.
Speaking to journalists about the upcoming Palliative Care Day, Mark Mwesigwa, Executive Director of the Palliative Care Association of Uganda (PCAU), highlighted the challenges Uganda faces in accessing essential medicines, rather than issues of misuse. “Only 15 percent of patients who need pain relief can access morphine, which is worrying. It is not time to tighten restrictions; we should focus on preventing misuse while ensuring accessibility,” Mwesigwa stated.
He further warned that Uganda’s efforts to regulate morphine use are premature, as the country has not experienced significant misuse compared to some Western nations. “Over 80 percent of the population that needs morphine cannot access it. The system should aim for a balanced approach that allows for safe and effective pain management without unnecessarily restricting access.” He emphasized the need to safeguard against illicit use while ensuring the availability of drugs for medical and scientific purposes, stressing the importance of maintaining the “dual balance” principle championed by the WHO.
Meanwhile, Dr. Moses Muwanga, Commissioner for Palliative Care at the Ministry of Health, acknowledged the need for broader access to pain management medicines. He praised Uganda’s progress in integrating palliative care into the national healthcare system and urged continued efforts to expand these services. “Uganda has made significant strides in providing palliative care, including free access to oral liquid morphine at public health facilities,” he said.
According to Muwanga, revising the current wave of fear surrounding morphine use is crucial to ensuring that patients with chronic illnesses receive the pain relief they need. He noted that “the Ministry of Health and palliative care advocates continue working towards a system that strikes the right balance between preventing drug misuse and ensuring access to life-saving pain management.” He added that, as a measure to prevent misuse, morphine production is limited to Hospice Africa Uganda, which supplies only to National Medical Stores and Joint Medical Stores for distribution to accredited health facilities. Supplies are based on demand availability.