88 The morphine access divide: measuring the unmet need for oral morphine in an adult homecare hospice in Ethiopia

<h3>Introduction</h3> Half of the global population receives less than 1% of global morphine supply,¹ yet 80% of those most in need of palliative care live in low- and middle-income countries² where this scarcity of morphine exists. Ethiopia has a high burden of terminal illness owing to late diagnosis and limited treatment options, yet its palliative care service is nascent and there is minimal availability of oral morphine. The Ethiopian government is currently considering opening its first morphine production unit to address this problem. This audit was undertaken to identify the previously unmeasured burden of uncontrolled pain and access to oral morphine in a cohort of adult patients from Hospice Ethiopia, a community palliative care service in Addis Ababa. <h3>Method</h3> An audit was completed on 100 patient records from Hospice Ethiopia. The patient records were chosen at random from the archives of patients with a diagnosis of either cancer or HIV who had died between 2010 to 2024. <h3>Results</h3> 95% of patients with cancer, and 100% of patients with cancer and HIV reported pain. On first assessment visit, the average pain rating was 3.85 out of 5 and only 5% of patients had controlled pain. By final clinical visit, 60% of patients had controlled pain. 33% of patients had constant access, and 15% had intermittent access, to oral morphine. After 2021, only 24% of patients had constant access to oral morphine. <h3>Conclusion</h3> There is a large and unmet need for effective pain control in patients living with terminal illnesses in Ethiopia. Closing the global morphine access divide by achieving universal access to palliative care and effective pain control is an urgent imperative. Recommendations from the 2018 Lancet Commission Report² should be followed to achieve this and the international community should support the Ethiopian government in opening its first morphine production unit. <h3>References</h3> Knaul FM, Bhadelia A, Rodriguez NM, Arreola-Ornelas H and Zimmermann C. The Lancet Commission on Palliative Care and Pain Relief—findings, recommendations, and future directions. <i>The Lancet Global Health</i> 2018;<b>6</b>:S5-S6. Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete XJ, Arreola-Ornelas, H, Gómez-Dantés O, Rodriguez NM, Alleyne GA and Connor SR. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report. <i>The Lancet</i> 2018;<b>391</b>(10128):1391–1454.