Tanzania is running out of morphine — a key reliever of severe pain for patients with terminal illnesses.
The Ocean Road Cancer Institute, which procures and supplies the drug to compounding units, has raised the alarm over the shortage, which has persisted since last year.
An institute official, who spoke on condition of anonymity told The EastAfrican that they had only two tins of opioid, which cannot last a month.
Morphine is used by cancer patients, and other patients suffering severe pain.
The institute has since June 2018 been seeking the drug from the Tanzania Medical Stores Department, the sole importer of morphine powder and other controlled drugs in the country, to no avail, the source said.
Mwanashehe Juma, an MSD official based in Dodoma, who spoke to The EastAfrican on the sidelines of a pharmacists workshop in Arusha last Thursday, admitted that the department had received the morphine order from the Ocean Road Cancer Institute.
She blamed the delayed import of the drug on tedious procurement procedures and the failure by a few foreign manufacturers of controlled medicine registered by Tanzania Food and Drugs Authority to apply for the supply tender the department had floated.
She said the drug could be available by next month.
Tanzania requires 588 tins of morphine of 100 grammes each—equivalent to 59 kilogrammes a year. But, due to financial constraints and lack of local capacity to manufacture controlled medicines, MSD has been ordering at most 411 tins, or 42kg per year.
Besides the cancer institute, MSD also supplies morphine powder to Mbeya Referral Hospital in Mbeya Region and Bugando Medical Centre in Mwanza Region.
Possession, use, trade, distribution, import, export, manufacture and production of morphine, an analgesic and narcotic drug obtained from opium and used medicinally to relieve pain, is tightly controlled globally to avert abuse and trafficking.
While pharmacists and medical doctors are the sole health workers allowed to prescribe oral morphine to patients suffering from terminal diseases, the Ugandan government chief pharmacist, Dr Fred Sebisubi, said nurses and clinical officers were also allowed to administer the drugs in the country.
With 1.5 million patients in need of palliative care service, Uganda boasts 90 palliative care facilities scattered around the country compared with 68 in Tanzania, Dr Sebisubi said.
The Tanzanian government’s chief pharmacist, Daudi Msasi, said the government would spend over Tsh200 million ($86,956) on subsidising morphine powder with effect from next financial year.
"The move aims at reducing the price of the drug to TSh5,000 ($2.2)," he said.
The Ocean Road Cancer Institute has since 2017 been selling morphine powder to compounding units at Tsh6,000 ($2.6) a litre, up from Tsh5,000 ($2.2) per five litres in the past.
This has led in compounding units to raise the price of oral morphine to between Tsh8,000 ($3.5) and Tsh10,000 ($4.4) a litre, as pharmacists in some units spend up to four days travelling to fetch the drug.
Matema Beach View Hospital on the foothill of Mount Livingstone overlooking Lake Nyasa in the Southern Highlands, for instance, said it spends Tsh500,000 ($217) on bus fare and per diem for fetching morphine powder from the cancer institute in Dar es Salaam.
Mr Msasi said five zonal morphine compounding units would be established by next year to reduce the distance problem.
Save for the Ocean Road Institute and faith-based organisations in Tanzania, most of the government’s healthcare facilities are not providing palliative care services.
He said the government would ensure each regional referral hospital is registered to prescribe and dispenses oral morphine by next year.