Pain Control

The cornerstone of Hospice care is pain control.

For the dying, dignity and comfort often means prescribing powerful drugs. Of which The most important is morphine. Since it is derived from opium, it is a controlled drug and many governments refuse to make it available for medical use. So most Africans with cancer, AIDS, sickle-cell disease, victims of car crashes, gunshot and machete wounds,suffer severe pain without relief.

“About 200,000 people need pain control in Uganda and millions more across the continent.”


Palliative Care nurse educating patient on medication

In Africa, patients suffer severe pain without relief as access to the most effective analgesic – morphine – is restricted. An overly bureaucratic approach to regulating the drug in less developed countries is an abuse of human rights. The World Health Organisation says it will be a generation before chemotherapy and radiotherapy will be available in poor developing countries and that morphine is an essential drug for cancer patient’s pain relief. It is cheap, easy to produce, relatively easy to administer by trained healthcare professionals. But access continues to be an issue. Hospice Africa Uganda demonstrates that the barriers to prescribing morphine can be overcome. Access to pain control at end of life was denied until HAU developed an affordable way of manufacturing and distributing liquid morphine.

HAU founder,Dr. Anne Merriman has developed a model of palliative care which is now being adopted throughout Sub Saharan Africa. She has received a licence from the government in Uganda to import powdered morphine from Europe. She has developed a formula to make up liquid morphine cheaply. Initially, recycled plastic water bottles were filled with oral morphine, colour coded for different strengths—green for the weakest, then pink, and blue for the strongest. Today a more sophisticated liquid morphine production unit is operated by HAU under contract for the whole Ugandan health service! 

Access to a simple morphine delivery system has allowed the hospice to set up teams who visit critically ill patients in the community. The morphine is provided and with advice from trained nurses the patients or their families administer the doses.

Hospice Africa Uganda imports £3,000 worth of morphine each month

morphine-mixingOver the last 3 years morphine consumption in Uganda has trebled. Meeting this increased demand has been possible because of the continuing public-private partnership between HAU, the National Medical Stores,the Government of Uganda and several stakeholders. With a second contract going into effect this year this partnership has proven to be a successful program toprovide the needed oral liquid morphine to accredited health centres.To respond to the growing demand, which is notexpected to slow, HAU has partnered with Treat the Pain of the American Cancer Society to make necessary infrastructure modifications and procure needed equipment. This will mean a 7 fold increase in the ability to produce morphine.

About 200,000 people need pain control in Uganda and millions more across the continent.

It is estimated that 80% of the global consumption of morphine is in six western countries. The remaining 20% is consumed by 142 countries. The average consumption per person annually across Africa is 18 times lower than the world average.