ISLAMABAD: Thousands of cancer patients, including children with advanced stage of cancers, are being deprived of effective pain relief after supplies of essential opioid medicines, including injectable and oral morphine and fentanyl, have run out at major hospitals across Pakistan, oncologists and pharmacists said on Thursday.
They claimed that pharmaceutical manufacturers have been unable to produce these critical medications due to delays in government approval of quotas for importing controlled narcotic raw materials as well as pricing disputes with the government.
The shortage has affected some of the country’s leading cancer treatment centres, forcing doctors to rely on weaker painkillers that specialists say cannot adequately control severe cancer pain.
Hospital pharmacists and pharmaceutical industry officials blamed the crisis on prolonged delays in approving annual quotas for controlled narcotic Active Pharmaceutical Ingredients (APIs), import authorisations and other regulatory clearances. They warned that even if approvals are granted now, fresh supplies are unlikely to reach hospitals before October or November.
Arif Arain, senior pharmacist at a Karachi hospital , confirmed that the hospital had already exhausted its stocks of injectable morphine and fentanyl, while oral morphine capsules were expected to last only a few more days. “We have no injectable morphine or fentanyl available. Our remaining stock of oral morphine capsules will also finish within days. These medicines are indispensable for cancer patients receiving palliative care, and there is no equally effective substitute for severe cancer pain,” he said.
Morphine and fentanyl are regarded as the gold standard for treating moderate to severe cancer pain and are recommended by the World Health Organization for palliative and end-of-life care. Unlike ordinary painkillers such as paracetamol, diclofenac and ibuprofen, these opioids act on the central nervous system to relieve intense pain caused by advanced cancers involving bones, nerves and internal organs.
Cancer specialists say patients with metastatic breast cancer, pancreatic cancer, bone tumours, advanced head and neck cancers and childhood cancers such as neuroblastoma and osteosarcoma often suffer pain that cannot be controlled with conventional medicines.
The mother of an eight-year-old child with advanced neuroblastoma said doctors were now using ordinary pain medicines because morphine and fentanyl were unavailable. “My son cries in pain throughout the night. The medicines he is receiving are simply not working anymore. As a mother, I can only watch him suffer. No parent should have to see their child dying like this,” she said.
According to pharmaceutical industry officials, manufacturers have been unable to produce morphine and fentanyl because annual allocations of controlled narcotic raw materials have yet to be approved. Under Pakistan’s regulatory system, companies cannot import narcotic APIs until quotas are allocated and import permits and other regulatory approvals are completed.
The shortage comes as the World Health Organisation identifies palliative care as one of the weakest components of global cancer control. According to the WHO Global Status Report on Cancer 2026, around 73 million people require palliative care every year, but only 14 per cent receive it. Pakistan recorded an estimated 185,748 new cancer cases and 118,631 cancer deaths in 2022, highlighting the growing need for effective pain management. The WHO says palliative care should be integrated into comprehensive cancer services, but millions remain without adequate pain relief.
When contacted, a senior official of the Ministry of National Health Services, Regulations and Coordination said the ministry had not been informed about any nationwide shortage of morphine or fentanyl. “Nobody has formally brought this issue to the notice of the ministry or the Drug Regulatory Authority of Pakistan. There is a committee that regularly monitors the availability of essential medicines, and we will examine the matter if shortages have occurred,” he said.
