Hi Eduardo,
Thank you for your reply!
I hope that some further answers will come from practitioners in India that will be able to help understand this problem there. But without wishing to speak on anyone’s behalf, when I was interviewing Indian palliative care doctors on this question, several issues came up frequently. In the first instance, the highly restrictive regulations established through the 1985 Narcotic Drugs and Psychotropic Substances Act play a significant role in limiting access. But another issue came up quite frequently. Many people said that a drug such as morphine would arise when learning in medical school, such as in pharmacology lectures/textbooks. But that once new doctors had started professional practice, they would almost never see it being used by those above them. As medical education seems very experiential in nature - as much is learned after medical school through professional guidance from more experienced physicians - the use of opioids for palliative/analgesic purposes seems to fall from the ongoing professional development of young doctors. It would be interesting to hear whether this account sounds familiar to any clinicians taking part in the discussion.
Best,
Nick
HIFA profile: Nick Surawy Stepney is a Wellcome Trust research fellow at the University of Exeter. A medical anthropologist, his current research project 'Drug Addiction and De-addiction in India: Genealogies, Politics and Practices' utilises ethnographic and archival methods to examine how ‘addiction’ is imagined and intervened upon in medical settings in north India. He completed his PhD in anthropology at the department of Global Health and Social Medicine at King’s College London in September 2022, with a project analysing the material and symbolic circulations of morphine in Indian cancer care. Subsequent to this, he was a postdoctoral research associate at King's, on the project ‘Grid oncology: remaking cancer care in India’. N.Surawy-Stepney AT exeter.ac.uk