Prospects used to be bleak in Nigeria in regards to pain management and palliative care, with an estimated 180,000 deaths annually in untreated pain. Opioid consumption was negligible with an average opioid coverage rate of 0.2% between 2008 and 2010.
Erratic availability of opioid analgesics coupled with administrative bottlenecks of a centralised system in a country as large as Nigeria compounded the issue, resulting in low prescription rates by doctors. In fact, the last batch of morphine powder expired in the Central Medical Stores without being picked up by hospitals in the country, even as patients suffered from pain.
Concerned pain specialists, caregivers, health professionals and palliative care advocates are frustrated watching their patients and loved ones suffer in pain. Advocacy has been ongoing at different levels by non-governmental organizations, civil society associations, and key individuals in pain management and palliative care in Nigeria, both within and outside of the country.
The Global Access to Pain Relief Initiative (GAPRI) got involved in Nigeria as a result of these advocacy efforts, and in 2011 started a collaboration with the Federal Ministry of Health (FMOH) to improve availability and access to essential medicines for pain management.
The massive need in Nigeria can be intimidating, but thanks to the willingness of the government to take on the problem and the persistent efforts of national stakeholders, including the Hospice and Palliative Care Association of Nigeria (HPCAN) and the Society for the Study of Pain (SSPN), a multi-sectoral approach is being developed to expand access to pain relief.
GAPRI has been involved in networking in Nigeria, leveraging government support and bringing together important stakeholders involved in the area. GAPRI’s strategy in Nigeria is to ensure opioid availability for the treatment of moderate to severe pain and to generate demand among prescribers and patients.
The government has procured approximately 20 kilograms of oral morphine powder, which arrived in to Central Medical Stores at the end of November. The Food and Drug Services Department of the FMOH and the National Agency for Food and Drug Administration and Control (NAFDAC) are also developing Standard Operating Procedure Manuals (SOPs) for producing oral morphine solution, in partnership with GAPRI.
Strengthening the infrastructure for production and distribution
The government is renovating the Federal Manufacturing Laboratory in Lagos for production of oral morphine solution. In addition, pharmacists from selected tertiary hospitals across the country will be trained by GAPRI in collaboration with HPCAN on production of oral morphine solution. They will use the SOPs to produce oral morphine solution for their patients; other hospitals within their regions will be able to pick up oral morphine solution for their patients with the proper documentation and approvals. Consumption will be tracked by these pharmacists and reported back to the FMOH and NAFDAC.
In addition, GAPRI is working with HPCAN and the SSPN to develop a curriculum for a one-day awareness workshop in these tertiary hospitals. The workshop will sensitize the caregivers within these hospitals on pain management, measuring pain, and dosing and administration of morphine to ensure proper utilization. Each of these hospitals also has pain management professionals on staff who will support their colleagues after the workshop.
GAPRI recently donated 5 kilograms of Bronopol crystals to the FMOH. Bronopol is a preservative that extends the shelf-life of oral morphine solution to six months.
The journey is long and challenging, but with everyone working together patients in Nigeria will no longer endure pain, and palliative care can be a reality in a nation with such a dire need.