Rajagopal M R, Karim Safiya, Booth Christopher M
M.R. Rajagopal, Trivandrum Institute of Palliative Sciences and Pallium India, Trivandrum, India; and Safiya Karim and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada.
J Glob Oncol. 2017 Dec;3(6):720-727. doi: 10.1200/JGO.2016.007872. Epub 2017 Feb 8.
Purpose Access to opioids for pain control is recognized as an urgent issue in low- and middle-income countries. Here we report temporal and regional trends in morphine use in Kerala, India. Methods Oral morphine use data for the State of Kerala (2012 to 2015) was used to describe temporal trends, regional variation, and provider characteristics. Total morphine use was calculated for each district of Kerala to derive an annual per capita use rate (milligrams per capita). Each provider was classified as government, private, nongovernment organization (NGO), or NGO partnership. Results Oral morphine use for Kerala was 1.32 mg/capita and increased over the study period 27% (from 1.23 mg/capita to 1.56 mg/capita). There was substantial variation in morphine use across districts (range, 0.49 mg/capita to 2.97 mg/capita; six-fold difference). This variation increased over time (19-fold difference in 2015). In 2015, 31% of morphine providers (51 of 167) were government institutions; they delivered 48% of total morphine in Kerala. Corresponding data for other providers are private institutions, 23% of centers and 13% of morphine; NGOs, 41% of centers and 34% of morphine; and NGO partnerships, 5% of centers and 4% of morphine. From 2012 to 2015, the total number of centers increased by 35%, from 124 to 167. Conclusion Oral morphine use has increased over time in Kerala but remains substantially lower than estimated need. There is significant geographic variation of use. Efforts are needed to improve palliative care in Kerala and to reduce regional disparities in access to opioids.
目的 在低收入和中等收入国家，获取用于疼痛控制的阿片类药物被视为一个紧迫问题。在此，我们报告印度喀拉拉邦吗啡使用的时间和地区趋势。方法 利用喀拉拉邦（2012年至2015年）的口服吗啡使用数据来描述时间趋势、地区差异和提供者特征。计算喀拉拉邦每个区的吗啡总使用量，以得出人均年使用率（毫克/人）。每个提供者被分类为政府、私立、非政府组织（NGO）或NGO合作伙伴关系。结果 喀拉拉邦的口服吗啡使用量为1.32毫克/人，在研究期间增加了27%（从1.23毫克/人增至1.56毫克/人）。各地区的吗啡使用量存在很大差异（范围为0.49毫克/人至2.97毫克/人；相差六倍）。这种差异随时间增加（2015年相差19倍）。2015年，31%的吗啡提供者（167个中的51个）是政府机构；它们提供了喀拉拉邦吗啡总量的48%。其他提供者的相应数据为：私立机构，占中心的23%和吗啡的13%；非政府组织，占中心的41%和吗啡的34%；以及NGO合作伙伴关系，占中心的5%和吗啡的4%。从2012年到2015年，中心总数增加了35%，从124个增至167个。结论 喀拉拉邦的口服吗啡使用量随时间增加，但仍远低于估计需求。使用情况存在显著的地理差异。需要努力改善喀拉拉邦的姑息治疗，并减少获取阿片类药物方面的地区差异。
