Every Indian state has its own version of the Narcotic Drugs and Psychotropic Substances Act of 1985, which regulates morphine and other similar drugs. The Act requires extensive paperwork; records must be maintained for several years. It also authorises the government to conduct raids, and put suspected wrongdoers behind bars, without bail. Even clerical errors — bound to occur with such extensive documentation — could be viewed with suspicion. This has dissuaded doctors and chemists from storing the drug. “The procedures involved are often strict and cumbersome, and… this has caused undue suffering and harassment,” Singh wrote in his letter.

Opium production is also state-owned. Drug companies can only formulate the morphine powder bought from government units. This is true of other narcotics as well. Recently, Mumbai’s Nicholas Piramal took a Rs 25 crore hit on sales of cough syrup Phensedyl. The supply of its key ingredient, codeine (another opiate) is controlled by the government. “For nine months, there was no supply from the government factory,” says Ajay Piramal, chairman, Nicholas. And government took its own time importing it. No wonder, then, that only three private formulators of morphine exist in India, according to Ghooi. In states with simpler procedures, supply is a constraint. “There just isn’t enough,” says Shona Nag, a cancer specialist at Pune’s Jehangir Hospital. It is not uncommon for patients to have to rush from hospital to hospital to get their stock, she adds. Nag, who studied in Australia, says doctors there “use morphine liberally”. The developed world, according to the INCB, is the largest consumer of medical morphine produced in developing countries.

But in India, even if the states simplified procedures, this would solve only part of the problem. “Two generations of doctors have grown up not using it (morphine),” says Rajagopal, who founded Kerala’s first palliative care centre. He identifies two reasons for this. First is the law, and second, the stigma associated with morphine use itself. “People see pain as inevitable, and painkillers as dangerous,” he says. Indeed, both Rajagopal and Bagai of CanKids...KidsCan believe that the issue is symptomatic of a larger problem.