BENGALURU: Relief from excruciating pain and suffering, and ensuring comfort and dignity of life to a terminally ill patient is at the heart of palliative care. Kidwai Memorial Institute of Oncology (KMIO), Bengaluru, was the first cancer institute in Karnataka and perhaps among the first in India to have started a palliative care unit, albeit on a small scale way back in 1988 with use of morphine (given free) for pain management of terminally ill cancer patients. 

“At Kidwai, we follow the World Health Organisation (WHO) protocol for cancer treatment, which involves steps 1, 2 and 3. The latter is regarding the use of narcotic for pain management for terminally ill people. Kidwai uses the maximum amount of morphine in the country for patients, who are under palliative care,” Dr C Ramchandra, Director, KMIO,  told TNIE.     

Morphine is the main alkaloid of opium, which has been recognised worldwide as the most potent analgesic for chronic pain. In India it is banned under the Narcotic Drugs & Psychotropic Substances (NDPS) Act, 1985. In 2014, the Act was amended for easier access of morphine strictly for medicinal use by Registered Medical Institutes (RMIs). 

“The Kidwai palliative care unit has been using 10 to 12 kg of morphine annually, which is the highest in the country. On an average the institute receives 1,200 new patients and 10,000 followup cases annually for morphine alone,” said former KMIO director Dr KB Linge Gowda, who along with former senior specialist, Dr PV Ramamani, Dr Nagesh Simha (of hospice Karunashraya) and others had authored the Karnataka Palliative Care Policy, 2016. 

“Palliative care provides physical, psychological, spiritual and social care to terminally ill people. They wish to die in dignity and without pain. Seventy to 80 per cent of cancer patients come to Kidwai in advanced stages, when curative treatment is no longer an option,” said Dr Gowda.   “The morphine dose varies from patient to patient and also on the severity of pain. It is always given four hourly for immediate release,” he added. 

Procurement of morphine is regimented under licence and permission of the State Drug Controller. “The RMIs have to requisition for morphine through the Drug Controller, who after clearing it, forwards it to the Revenue Ministry for authorisation. The allotment of the opioid for the RMIs is confirmed by the Narcotics Control Bureau and the drug is procured from the Government Opium & Alkaloid Factory, Neemuch in Madhya Pradesh.  

“There are myths surrounding the use of morphine such as addiction, respiratory depression and death. There are side effects too such as constipation, nausea, vomitting which can be controlled with drugs,” said the former director. Dr Gowda stressed on the role of volunteers in palliative care. “It’s a team effort comprising  doctors, nurses, social workers, pharmacists, physio therapists and volunteers,” he said.