Trials of low-cost opioid alternatives where morphine supply is unreliable
When morphine is unavailable, patients get nothing. Some cheap alternatives, such as methadone or tramadol, may work for cancer pain but have not been properly tested in these settings.
Morphine stock-outs are common in LMICs, leaving patients without analgesia. Methadone is inexpensive, long-acting, and effective for cancer pain but needs careful titration; tramadol is widely available but weaker and not internationally controlled, which affects supply differently. Pragmatic trials of protocolised methadone or tramadol-based regimens delivered by nurses in settings with unreliable morphine would establish safe fallback options and could inform essential medicines lists.
- 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.
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