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Rwanda Makes Own Morphine to Serve Poor Patients

Rwanda is aiming to provide free medicine to all its citizens who suffer from pain caused by life-threatening illnesses.

The country is leading efforts to produce the painkiller morphine locally. That would mean the country would not have to depend on costly opioid medicines sold by large companies.

Experts say large drug companies cannot make a lot of money selling low-cost, generic morphine to the poor and dying in countries like Rwanda. Most people in sub-Saharan Africa do not have the money to pay for costly opioids like oxycodone and fentanyl.

In this photo taken Tuesday, Nov. 5, 2019, palliative care nurse Madeleine Mukantagara, 56, left, uses a pulse-oximeter to check on the health of Vestine Uwizeyimana, 22, right, who has spinal degenerative disease and is taking oral liquid morphine.

In this photo taken Tuesday, Nov. 5, 2019, palliative care nurse Madeleine Mukantagara, 56, left, uses a pulse-oximeter to check on the health of Vestine Uwizeyimana, 22, right, who has spinal degenerative disease and is taking oral liquid morphine.

About 90 percent of opioids are used by people in the world's richest nations -- where just 17 percent of the world's population lives. Those estimates come from the International Narcotics Control Board, or INCB. Most users of opioids are in the United States, Canada, Western Europe and Australia.

In much of the world, a rise in opioid prescriptions began in 1997, INCB data examined by The Associated Press shows. Since then, opioid use worldwide has increased by three. The rise led to a massive increase in opioid addiction in the world's wealthiest countries.

However, this rise in painkillers only involved costly opioid products that became very profitable for large drug companies, INCB data showed. The use of morphine, which costs far less and is considered one of the most dependable painkillers, remained flat.

Morphine produced by large manufacturers costs, in general, six times more in many low- and middle- income nations than in wealthy ones, the INCB reports. Experts say this is partly because small countries with low opioid usage rates are not in a position to negotiate prices with drug companies.

A major study by the Lancet Commission on Global Access to Palliative Care and Pain Relief recently examined the inequality between rich and poor countries. The study estimated that it would cost just $145 million a year to provide enough morphine to ease end-of-life suffering around the world. Yet millions still suffer without pain medication in the poorest places.

So, a growing number of African countries – including Rwanda, Kenya and Malawi – have begun to make and give out morphine on their own. The efforts generally include cooperative activities between governments and nonprofit organizations.

"Pain is...torture," said Diane Mukasahaha, who leads Rwanda's national effort for palliative care. She told the AP she had seen patients without morphine nearly starve to death because they were too sick to eat. "People should have medication like an American person. We are all human beings. The body is the same."

Madeleine Mukantagara, a 56-year-old nurse, provides morphine to pain sufferers. On a recent day, she walked through fields in a rural area of Rwanda to get to her first patient of the day, Vestine Uwizeyimana.

For 15 years, the 22-year-old Uwizeyimana dealt with severe pain as a disease damaged her spine. She could no longer walk and had trouble even turning over in bed. Her life narrowed to a small, dark room with a dirt floor. Then, one year ago, relief came in the form of locally produced liquid morphine.

"Without this medicine I think I would die," Uwizeyimana said as her nurse arrived. Mukantagara sat on the edge of her patient's bed and the two began with a prayer.

"Now I think everything is possible," Uwizeyimana said. The nurse and patient held hands and prayed again, quietly. Uwizeyimana then closed her eyes.

Another patient of Mukantagara is an 89-year-old woman who has been sick for five years and has been taking liquid morphine for three of those years. "With pain relief I can eat. I can go outside," the patient said. "I can greet my neighbors. I can walk slowly, slowly and go to church."

Like other painkillers, liquid morphine can be addictive and abused. But the Rwandan government has taken control of the supply in an effort to prevent mass shipping of pills -- which helped fuel the opioid crisis in the United States and other countries.

In Rwanda, the drug is only given to the nation's sickest people. And only the supplier of morphine powder makes money -- which prevents mass marketing efforts aimed at expanding sales.

Words in This Story

opioid – n. a drug that is opium based and used to reduce pain

generic – adj. a product that is not sold with the name of the company that produced it

prescription – n. an order written by a doctor that says a patient can be given a medicine or treatment

income – n. money that is earned by working, investing, or producing goods

palliative – adj. relieving pain without dealing with the cause of the condition

church – n. a building where Christians go to worship