Islamabad:Nearly one million people in Pakistan need palliative care every year, including patients with cancer, tuberculosis, HIV and AIDS, diabetes and advanced heart failure, yet barely 15,000 to 30,000 manage to access these services because of a severe shortage of trained specialists and long standing barriers to essential pain medicines, say health experts.
They said some of these gaps were now being addressed as the Drug Regulatory Authority of Pakistan (DRAP) moves to simplify procedures and introduce an online system to improve the availability of opioid medicines for hospitals, starting with the federal capital.
The assurance was given during a coordination meeting on controlled drugs regulation and palliative care communication held at the Health Services Academy, where DRAP Deputy Director Muhammad Ansar said concrete steps were under way to ensure timely access to pain relief for patients with life limiting illnesses.
The meeting was jointly presided over by Dr Samia Latif of the Special Interest Group Pakistan, linked with the UK Faculty of Public Health, and Health Services Academy Vice Chancellor Prof Shahzad Ali Khan.
Experts from Pakistan and the United Kingdom attended the session both in person and online, including clinicians, pharmacists, public health specialists, regulators and representatives of international organisations.
DRAP official Muhammad Ansar said procedural formalities were being reduced and a new digital procurement system had been developed that would cut approval timelines for controlled drugs from more than four months to as little as two to four weeks.
He said the system would initially be piloted in Islamabad before being expanded nationwide, adding that DRAP was granting registration for oral morphine syrup to ensure its availability for children suffering from severe pain.
He said the authority was also preparing to allow the import of modern pain management medicines, including fentanyl and buprenorphine patches, which are commonly used internationally in palliative care.
Ansar said tramadol would soon be added to the list of controlled substances and would be strictly prescription based, with tighter controls on its active pharmaceutical ingredient to prevent misuse while ensuring legitimate medical use for patients.
Prof Shahzad Ali Khan said palliative care remained an essential but neglected component of Pakistan’s health system, warning that an excessive focus on cure had left thousands of patients to endure avoidable pain and distress. He said improving access to pain medicines, building a trained workforce and correcting misconceptions around opioid use were critical if the health system was to deliver care with dignity and compassion.
Dr Samia said palliative care focused on improving the quality of life of patients and their families by addressing physical, psychological, social and spiritual suffering. She said many patients and even doctors mistakenly viewed palliative care and opioid use as a sign that death was imminent, leading to delayed referrals and unnecessary suffering. Regulators and other stakeholders, she said, had a central role in creating systems that allowed access to essential medicines while maintaining accountability and preventing diversion.
Highlighting the scale of the problem, Dr Waseem Gill said Pakistan remained far behind both regional and high income countries in access to opioid medicines. He said Pakistan’s annual morphine allocation stood at around 20 kilograms, while per capita access in Bangladesh was many times higher and India’s was several times greater.
Even this limited quota, he said, was underutilised, with reported morphine consumption in Pakistan not exceeding seven kilograms in recent years, reflecting deep systemic barriers rather than a lack of clinical need among patients.
Kamran Niaz of the United Nations Office on Drugs and Crime said international drug control conventions were designed to ensure the availability of controlled medicines for medical use while preventing abuse, but overly restrictive practices in many countries had created a global pain gap.
