ideasIdea
Locally prepared oral morphine solution, licensed for nurse prescribing
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.
Hospice Africa Uganda pioneered reconstitution of oral morphine solution from imported powder at very 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.
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.
What would test it
Implementation in three countries with morphine dispensed, patients served, home pain scores, and diversion reports as endpoints.
Maturity
being tested at scale
Who has to act
policy
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- Pain relief and palliative care are unavailable to most · Most people who die of cancer worldwide do so without adequate pain relief.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
- Not enough oncologists, nurses, pathologists, physicists · The number of people with cancer is rising faster than the workforce trained to treat them.