Behind the headlines, Tanzania was hit by an acute shortage of morphine that lasted two months, with the result that thousands of patients in the county suffering from cancer, Aids, epilepsy, serious lung conditions and other long-term illnesses, were missing out on medication they need on a regular basis.

“They lived through hell in February and March,” Twalib Ngoma, director general of the Ocean Road Cancer Institute, told The EastAfrican. He said liquid morphine is prescribed to about 150 in and outpatients a day — the majority of them suffering from cancer and HIV and Aids.

Morphine, which is derived from opium, is used to treat moderate to severe pain among patients by dulling the pain perception centre in the brain.

The shortage hit three months ago, after the normal one-year stock was exhausted.

The country turned to Kenyan based Laborex Ltd, but the Mombasa firm was able to supply only one kilogramme — sufficient only for the month of January.

“There is a global shortage of the drug as we placed our order four months before our stock ran out, but the Medical Stores Department failed to secure a supplier,” Dr Ngoma said.

Dominica Meena, the public relations officer at the Medical Stores Department, said there is a drug availability problem globally because the supplier, Harsh Pharmaceutical of Tanzania, the agent of Johnson & Johnson of the UK, came back to the Department in December asking for a deadline extension of 16 weeks to supply the drug.

The Department does not keep reserve stocks of the drug due to its nature and it is only procured after receiving an order from Ocean Road Cancer Institute, which keeps the usage track records.

Last week, the supplier finally managed to procure enough stocks to last six months.

The Ocean Road Institute handles 3,000 new cancer patients and up to 10,000 follow–up cases a year.

All hospitals get their supply through the institute because the drug is highly addictive and needs thorough documentation of previous usage before a fresh supply is released.

Sudden stoppage of morphine can result in unpleasant withdrawal symptoms even if an alternative drug is administered.

To avoid these symptoms, stopping the medication is done under close supervision.

According to Dr Ngoma, in the absence of the drug, the patients are given either morphine or Tramadol injections, which are not as effective as liquid morphine.

Both drugs are extended-release formulations that are used when around-the-clock pain relief is needed.

Regional needs

The East African Community member states are projected to require 77,169 grammes of morphine this year, according to the International Narcotics Board.

It estimates Kenya as having the highest requirement at 30,000 grammes, while Burundi has the lowest at 169 grammes. The morphine needs of Uganda, Tanzania and Rwanda are projected at 25,000, 20,000 and 2,000 grammes respectively.

However, many cancer patients fail to access the drug, due to the restrictive regulations.

According to vice-chairman of the Kenya Cancer Association David Makumi, the regulations on procurement, distribution and dispensing of morphine discourage many practitioners from handling it.

“One needs to do a lot of work to get it off the shelf,” Mr Makumi said.

The regulations require that the drug is prescribed by a medical doctor and dispensed by a pharmacist, but considering the reluctance to handle it, is not prescribed as often as it should.

However, not all cancer patients need morphine, since others have retractable pain that subsides after time.

According to Dr Jack Jagwe of the Uganda Hospice, it has been an uphill campaign around East Africa to persuade authorities to allow widespread use of the drug in response to the surge in cases of terminal cancer as bureaucrats cited the danger of addiction.

Hospice Uganda has been using morphine since 1993 and about half of its 15,000 patients have used the drug, but there has not been a single incident of addiction.

Dr Jagwe argues that the danger of addiction is almost non-existent if the drug is used in instances of extreme pain and arises only in cases of drug abuse.

Normally, the national drug authorities procure it in powder form, formulate it into injectables and distribute to user units who must return regular records of usage.

In Uganda it is available in all public hospitals and faith based hospitals.

Additional reporting by Cosmas Butunyi and Michael Wakabi