Nigeria: frequently asked questions about morphine availability

Morphine

The Nigeria Federal Ministry of Health has recently procured morphine sulphate powder for use in the treatment of moderate or severe pain. Below are some answers to frequently asked questions about accessing morphine in Nigeria.


How do I get morphine powder for my hospital?

Accredited public hospitals may pick up morphine powder from Federal Medical Stores, Oshodi, Lagos once they have received approval from the Federal Ministry of Health. The Federal Ministry of Health has developed a standard operating procedure (SOP) for procurement which you can download here: Morphine Powder Collection SOP.pdf.


How do I use morphine powder?

At the moment the Federal Ministry of Health is stocking morphine powder. Hospital pharmacists will need to reconstitute the morphine powder into an oral morphine solution (OMS) by mixing it with purified/de-ionized water, bronopol preservative, and some green food colouring. Morphine solution should be dispensed to patients in clean, labeled amber bottles. Reconstitution is relatively easy and can be done by any qualified pharmacist. The Federal Ministry of Health has developed an SOP for oral solution production which you can download here: Oral Morphine Solution production SOP.pdf.


What is bronopol and how do I get it?

Bronopol is a preservative which will extend the shelf life of the morphine solution to 6 months. Without preservative, the shelf life of morphine solution is just 4 weeks. The Federal Ministry of Health provides bronopol to hospitals for free and it is automatically co-packaged with every morphine powder order.


What kind of records do we need to keep and send back to NAFDAC?

The FMOH and NAFDAC have created a tracking tool for morphine production, and one for morphine dispensing. You can download the tools in one Excel file here: Oral Morphine solution tracking tool.xls They have also developed job aids for the tool that you can download here:
OMS Production tool Job aid.pdf
OMS Consumption tool Job aid.pdf

The scanned forms or Excel files should be sent to ncs@nafdac.gov.ng and cmsoshodi@yahoo.com on the 15th of the month following the reporting month and hard copies must be submitted at subsequent pick-ups of morphine powder from Federal Medical Stores.

Why do we add green food colouring to the morphine?

In Nigeria, we add green food colouring to oral morphine solution that is 5mg/5mL. This is to make it easy to distinguish from water, to make it easy for health workers and patients to identify the strength of the solution, and to conform to standard practice in other countries in the region. Some countries produce solution in higher concentrations and use other colours to denote higher-concentration solutions.

What if my hospital doesn’t have a qualified pharmacist?

Hospitals without a qualified pharmacist will not be able to pick up morphine powder from Federal Medical Stores. For now, the only solution is to refer your patients to another facility for prescription. But new solutions are being developed to solve your problems. The Federal Ministry of Health is awaiting a delivery of morphine sulphate tablets and is also completing renovation of a laboratory to produce oral morphine solution. Soon, you’ll be able to purchase morphine tablets or oral morphine solution directly from Federal Medical Stores. If you wish to be notified when the tablets or solution become available for pickup at Federal Medical Stores, please email a request to nigeria@treatthepain.org and include your mobile number.

My hospital doesn’t have a water de-ionizer. Can we use bottled water instead?

Yes, you may use bottled water as long as you purchase it from a NAFDAC-certified supplier. Look for a NAFDAC registration number on the label. If you have any additional questions or problems accessing morphine, please send an email to nigeria@treatthepain.org.