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Rwanda’s cheap, generic morphine production model

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By putting morphine production and distribution under government control a, Rwanda has become a model for Africa.

As thousands die from addiction in rich countries awash with prescription painkillers, millions of people in the poorest nations have no access to opioids at all. CBS News reports that companies don’t make money selling generic morphine to the dying, and most in sub-Saharan Africa cannot afford the expensive formulations like oxycodone, prescribed so abundantly in richer nations that thousands became addicted to them.

The report says Rwanda’s answer: plastic bottles of morphine, produced for pennies and delivered to homes across the country by health workers. It is proof, advocates say, that the opioid trade doesn’t have to be guided by how much money can be made.

The report says 25 years ago, the killing of some 800,000 ethnic Tutsis and moderate ethnic Hutus left this country with an intimate knowledge of pain. Those who survived struggled to recover from ghastly machete wounds and cruel amputations. As Rwanda rebuilt itself, resilience was essential. Pain was to be endured, ideally without showing suffering.

But medical advances meant more people began living into old age and facing diseases such as cancer. Some thought their pain was punishment from God, recalled Dr Christian Ntizimira, a palliative care advocate. Yet, the report says, many doctors remained reluctant to use opioids. In much of the world, the use of opioids was exploding. Consumption has tripled since 1997, according to the International Narcotics Control Board. But the increase was in expensive formulations that are profitable for pharmaceutical companies, according to an analysis of INCB data. The use of morphine, the cheapest and most reliable painkiller, stagnated.

Commercially made morphine is on average nearly six times more expensive in many poor counties than it is in wealthy ones, the INCB has reported. Experts attribute it in part to countries with low opioid consumption lacking the negotiating power to import drugs at bulk prices. So, the report says, some African countries – Rwanda, Kenya, Malawi – began to make morphine on their own. They looked to Uganda, where the non-profit Hospice Africa Uganda was making liquid morphine in a process so basic it was mixed for two decades at a kitchen sink.

By putting production and distribution under government control and covering the costs for patients, Rwanda has become the new model for Africa. The liquid is produced from imported powder, said Richard Niwenshuti Gatera, a pharmacist and director of the production facility.

Like all opioids, morphine can be addictive. But, the report says, the Rwandan government has control over the supply to prevent what happened in the US, pills were shipped to tiny towns in quantities far exceeding justifiable medical need, said Meg O’Brien, whose Treat the Pain organisation helps poor nations produce morphine. The drug is reserved for the sickest people and there is no marketing effort to expand use.

The report says the movement is spreading slowly across Africa: 22 of 54 countries now have affordable morphine, according to Hospice Africa Uganda.

Full CBS News report

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