# Locally prepared oral morphine solution, licensed for nurse prescribing

Source: https://onco.cc/ideas/idea-acc-local-oral-morphine-production/  
OnCo record `idea-acc-local-oral-morphine-production` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Uganda makes liquid morphine from powder in a simple facility and lets trained nurses prescribe it, giving pain relief to patients that no doctor will ever reach. Other countries could copy this within a year.

## Summary

Hospice Africa Uganda pioneered reconstitution of oral morphine solution from imported powder at low cost, distributed through a public programme and prescribed by specially trained nurses and clinical officers under a 2004 regulation. The model has been documented and adapted in a handful of countries but not widely. A package combining pharmacy standards for reconstitution, a nurse-prescriber training curriculum, and model regulation would let ministries adopt it quickly.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Countries adopting local oral morphine production with nurse prescribing will increase the number of patients receiving opioid analgesia at home by at least fivefold within three years at a drug cost under $0.05 per day.
- Rationale: The Ugandan programme has run for more than two decades with no evidence of significant diversion; the constraints elsewhere are regulatory and logistical, both addressed by the package.
- Proposed test: Implementation in three countries with morphine dispensed, patients served, home pain scores, and diversion reports as endpoints.
- Maturity: being-tested-at-scale
- Actor: policy

## Sources

- Bottleneck evidence (Pain relief and palliative care are unavailable to most): WHO fact sheet, Palliative care: https://www.who.int/news-room/fact-sheets/detail/palliative-care

## Connected records

- ideas: [Home end-of-life care kits and trained family carers where no hospice exists](https://onco.cc/ideas/idea-acc-home-based-end-of-life-kits/), [National opioid quota reform so morphine reaches cancer patients](https://onco.cc/ideas/idea-acc-balanced-opioid-policy-reform/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Not enough oncologists, nurses, pathologists, physicists](https://onco.cc/bottlenecks/b-workforce/), [Pain relief and palliative care are unavailable to most](https://onco.cc/bottlenecks/b-palliative/)

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