“A good night’s sleep for patients without pain; Isn’t that we aspire for!”

“It’s a sad fact that even after amendments of NDPS rules, opioid analgesics are not reaching to those who needs them the most. And this, is now exacerbated by the pandemic situation and lockdown enforced due to it.”

– writes Dr. Anuja Damani and Dr. Arunanghu Goshal in an article on their effort to provide OPIOIDS safely to a patient who resides in a village a 2000 kms away from the hospital in Mumbai.

Often in media, we see reports like this. As a citizen of India, I’m concerned with misuse of opioids. Wearing the hat of a palliative care physician however brings a different perspective to the story.

It’s a sad fact that even after amendments of NDPS rules (which the news article refers as loosening of opioid laws) opioid analgesics are not reaching to those who needs them the most. And this, is now exacerbated by the pandemic situation and lockdown enforced due to it.

Take the example of Mr. Omprakash (name changed), a 42 year old daily wage earner suffering from advanced cancer of buccal mucosa taking morphine and methadone for his disease related pain. He went to his village in Uttar Pradesh (UP) during the mass exodus of migrants from Mumbai during lockdown. Unfortunately, he ran out of opioid analgesics soon and had to resort to paracetamol and other permissible over-the-counter medicines from local pharmacies. But it is of no avail to tame a pain like that from cancer. The agony forced him to look out for stronger opioid analgesics, but there weren’t any available at his place. He decided to call us up and requested to send him morphine and methadone from our dispensary, 2000 odd kms away , through a relative!

On hearing the story and after verification through telemedicine, we decided to do our bit for his pain relief, i.e. dispense required amount of morphine and methadone tablets. The impediment however was to reach his village in UP. The article 52E of NDPS act amendment of 2015, provides certain guidelines on sending essential narcotic drugs (ENDs) by post, courier, rail or road. Just at the nick of time, India Post came to our rescue. They deliver medication with proper documents in place.

After some efforts the government machinery worked and in few weeks the patient did receive his much awaited analgesia. At the time of writing this report, we got to know through telemedicine that he is comfortable, with his pain controlled and with a good night’s sleep. Isn’t that what we aspire for!

Article 52E, Narcotic Drugs and Psychotropic Substances (Third Amendment) Rules, 2015
The transmission of essential narcotic drugs by in-land post or courier or by rail or by road by a manufacturer, licensed dealer or licensed chemist is permitted, subject to the following conditions namely:

(i) the parcel of the essential narcotic drugs when sent by post shall be sent by registered post;

(ii) the parcel of essential narcotic drugs shall be accompanied by a declaration showing the names of consignor and consignee, the contents of the parcel in detail, the number of license or authorization or recognition held by the consignee;

(iii) the consignee shall show distinctly in his account books, if he is a licensee, the name of the consignee and the consignor respectively; and the quantity of the essential narcotic drug imported inter-State, exported inter-State or transported by and to him, as the case may be, from time to time, by post or by courier or by road or by rail.

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