Partnership with Pallium India to improve access to morphine for pain treatment

India project

Start of Project:February 2013
Length of Project: One year
Objective: Improve access to oral morphine for Indians with moderate or severe pain


Accurate data on the number of people with moderate or severe pain in India do not exist, but a minimum number can be estimated. The World Health Organization (WHO) estimated that 138,000 people died from HIV and 800,000 people died from cancer in 2010. Assuming that 50% of those who died from HIV and 80% of those who died from cancer experienced moderate or severe pain, 709,000 of those deaths required treatment with opioid analgesics, according to the WHO pain treatment guidelines. This number reflects a minimum need, since it does not include people who died of other conditions with pain, such as trauma or myocardial infarction and people who suffered with painful conditions but did not die.

The government of India reports opioid consumption to the International Narcotics Control Board on an annual basis. The average reported consumption of opioids from 2009-2011, standardized as morphine-equivalents, was 297 kg. Assuming that patients, on average, are treated for the last 3 months of their life with 67.5 mg of morphine per day, 297 kg would have provided a full treatment for 49,000 people. The amount of opioids required to treat 709,000 people is 4,380 kg. Please see our fact sheet on access to pain relief in India for more data.


India project

In February, 2013, GAPRI established a 1-year partnership with Pallium India to improve access to oral morphine for the treatment of moderate or severe pain.

The Pain-Free Hospital Initiative is a one-year hospital-wide quality improvement initiative to integrate pain treatment into service delivery by providing education for patients and staff, raising motivation and awareness, documenting pain levels, improving medicine supply, and communicating impact.

The Initiative is a low-cost intervention designed to demonstrate effectiveness and create local champions for pain relief. The program will target hospitals where pain relief is available, but remains under-prescribed. At the end of one year, participants in the Pain-Free Hospital Initiative will have created a model for incorporating pain treatment into clinical practice than can be replicated throughout the country.

The goal of the initiative is to implement a one-year program to integrate effective pain treatment into hospital-based services in three hospitals. The Pain-Free Hospital Initiative has five main objectives:

  1. Motivate clinicians to evaluate and treat pain

  2. Supply appropriate drugs to treat pain

  3. Equip clinicians with the skills and tools to effectively treat pain

  4. Measure the impact of the program

  5. Communicate the impact of the program