Two life experiences inspired Felicia Knaul, UM professor, director of the University of Miami Institute for Advanced Study of the Americas and first lady, to look into a global health crisis: losing her father to cancer and meeting a woman at a hospital in Mexico.
At the age of 18, Knaul’s father died of stomach cancer. During his illness, she said she struggled to get sufficient pain relief medication to alleviate his anguish.
Fast forward to 2012, when Knaul met a woman at a secondary level hospital in Mexico who had brain metastases.
“We had nothing to offer her, the health system had nothing to offer her,” she said.
During this same time, Knaul was working on “Closing the Global Cancer Divide,” a book outlining some of the major issues in cancer treatment, including global cancer care and control. She said one of the key problems with cancer turned out to be access to morphine, a pain reliever.
“I didn’t believe it was true until I saw with my own eyes all over Mexico that we didn’t have what we needed, even for children with cancer,” Knaul said.
The Lancet Commission Report on Global Access to Palliative Care and Pain, chaired by Knaul, was released on Oct. 12. For three years, researchers focused on studying accessibility to opioids in 172 different countries.
The study found that nearly 61 million people a year need palliative care and pain relief from illnesses such as HIV, cancer and heart disease, but only a small fraction, approximately 15 to 20 percent, receive it.
“The magnitude of the problem – enormous,” Knaul said.
According to the report, there are 298.5 metric tons of morphine available worldwide. However, across the globe, only 10.8 metric tons are distributed in low- and middle-income countries, and only 0.1 is in low-income countries.
UM President Julio Frenk, a senior author of the report, called the findings “disturbing.”
“It revealed one of the most extreme inequity instances across countries that I had ever seen in 20 years in global health,” he said.
Frenk has done extensive work in public health through the years, most notably as Mexico’s minister of health and at the World Health Organization.
Though the report found most countries around the world are suffering from an opioid disparity, the United States is suffering from an opioid epidemic, with the heart of it being right here in Florida.
According to the U.S. Department of Health and Human Services, 12.5 million people misused prescription opioids. The United States has an opioid surplus – nearly four times as many opioids needed to satisfy medical needs.
“You obviously don’t market to patients, but this is not an area where any for-profit entity should be pushing to expand the market,” Knaul said. “This is one where you need to have medically-designed, evidence-based guidelines that are managed by public policy.”
Knaul said one of the biggest problems the United States faces is the lack of universal health coverage. She said if countries like the United States leave people without health insurance, they’re going to get poor care, especially those with complex conditions, mental health issues, chronic pain and the like.
“They’re going to be pushed in directions that are sub-optimal,” Knaul said. “And one of them is to provide them with too much prescription pain medication.”
People in need of pain-relief medication in low- and middle-income countries can obtain morphine tablets for 16 cents per 10 milligrams. In high-income countries, people can obtain morphine for 3 cents per 10 milligrams.
The commission recommends a package of palliative care to be part of health systems worldwide. Knaul said in order for low- and middle-income countries to have morphine available to them at the same price as higher-income countries, it is necessary “to close the access abyss.” This would cost an estimated $1 million a year.
“One million,” Knaul said. “In any budget of any institution, it’s tiny. It’s $145 million to close the gap. To put that into context, that is a fraction of the annual operating budget of any medium-sized hospital in the United States.”