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Uganda Finds A Solution For Painkiller Shortage


Drugmakers in the U.S. flooded the market with powerful opioids, which helped fuel an epidemic of addiction, but there's massive shortage of opioids across Africa, even for patients who are in extreme pain. Uganda has come up with an unusual solution - going back to basics, taking one of the world's original painkillers and finding a way to dilute it so that it's safe, effective and cheap. NPR's Nurith Aizenman reports.

NURITH AIZENMAN, BYLINE: Nurse Resty Nakanwagi is rustling through a paper bag while her patient looks on. They're in the exam room of a hospice center. Nakanwagi pulls out two bottles filled with a green-colored liquid, sets them on a table.

RESTY NAKANWAGI: This is the morphine.

AIZENMAN: Morphine - powdered morphine mixed with water. It's become Uganda's go-to solution for extreme pain. They generally give out two-week supplies for patients to drink at home.

NAKANWAGI: So you are going to take this every four hours. And then at night, you make it a double dose.

AIZENMAN: The patient, Justine Nakayenga, has breast cancer that's metastasized. Nakayenga is a data entry worker for an insurance company - 30 years old. But she's lost so much weight, she looks like she could be 12. Two weeks ago, a tumor reached her spinal cord causing leg cramps so excruciating the pain was all she could think about.

JUSTINE NAKAYENGA: You're like, God, please get me through this. Please get me through this.

AIZENMAN: Then two days ago, she tried her first dose of liquid morphine. She says the pain was gone in a matter of hours.

NAKAYENGA: I went and laid down. Oh, my God, the sleep came. And I just drifted away until morning. I'm like, wow. I actually slept until morning.

AIZENMAN: Morphine and other painkillers related to it are routinely given to patients with extreme pain in the U.S. But those are sophisticated formulations with amped up potency and delivery systems, time-release capsules, pumps, that give you the right dose with the push of a button. And they've got price tags to match. By contrast, the liquid morphine recipe that Uganda uses...

ANNE MERRIMAN: You know, they say it's easier to make than a cup of coffee. It's only four ingredients.

AIZENMAN: Anne Merriman is a British nun turned doctor who founded this center, a nonprofit called Hospice Africa, to provide palliative care for terminally ill patients. She helped develop Uganda's liquid morphine setup back in the late 1990s.

MERRIMAN: I said look; this is affordable. It was - at the time, it was one dollar for 10 days treatment of the average patient.

AIZENMAN: And there's another draw. Merriman says this drinkable morphine setup is less likely to foster addiction than other forms of opioids.

MERRIMAN: It's so dilute. It's so dilute. It's not going to give you a high. They have to take an awful lot to get any form of a high.

AIZENMAN: When Merriman first proposed the idea, Dr. Ignatius Kakande was head of surgical training at Uganda's premier medical college. Like a lot of health officials, he had his doubts about morphine, or, as it's also called, morphia.

IGNATIUS KAKANDE: I think it was just a general fear - this belief, what we were taught, that morphia is a dangerous drug.

AIZENMAN: And it can be dangerous. But Kakande was frustrated with seeing so many of his patients suffer.

KAKANDE: It's just painful. You just send them home just to die in pain.

AIZENMAN: So Kakande arranged for Uganda's surgeons to be trained on how to prescribe liquid morphine. And as evidence mounted that it was making a difference without producing addiction, Ugandan officials decided to massively increase access. They passed a law allowing nurses to prescribe the mixture.

Dr. Emmanuel Luyirika heads the African Palliative Care Association. He says the new law was key because in Uganda, especially in rural areas...

EMMANUEL LUYIRIKA: The ratio of doctor to patient is so poor that you may wait for a year before you ever get a doctor.

AIZENMAN: Also, a few years after that, Uganda decided to provide the liquid morphine for free. In a country where more than 40% of the population lives on less than $2 a day, this is huge. The percentage of Ugandans getting the pain medication they need shot up from practically none to 11%. Unfortunately, it's remained stuck at that level.

LUYIRIKA: Funding is a major issue.

AIZENMAN: Luyirika says the government spends very little of its national budget on health care, and that includes the manufacturing of liquid morphine and training and deploying nurses to prescribe it.

Chris Ntege is head pharmacist at the government-funded facility where Uganda's morphine solution is mixed.

CHRIS NTEGE: One-fifty there.

AIZENMAN: He's scooping powder from a bag onto a scale.

NTEGE: Every time I weigh out the powder, I'm imagining that patient in the village who could be in pain, and you have here a powder that can take away all that pain.

AIZENMAN: The bag is now pretty much empty, but Ntege keeps scraping.

NTEGE: I don't want to leave even a small gram inside there.

AIZENMAN: Until Uganda starts producing enough, he says, every wasted gram means a patient is going to be left in pain. Nurith Aizenman, NPR News. Transcript provided by NPR, Copyright NPR.

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