Paper short abstract:

Morphine, an ‘essential’ analgesic, is rarely prescribed in many regions. Analysing its use in an Indian hospital, this paper displays the historical, social, and clinical stakes that complicate the 'demand' implicit to Global Health literatures that posit this problem as primarily one of ‘access’.

Paper long abstract:

The use of opioid drugs has become a key concern for global health communities. Typically, this has taken the form of research into ‘overuse’, often focussing on the USA. Yet there has also been a concerted effort to increase the visibility of the opposite problem; the absence and inaccessibility of strong opioid pain relief elsewhere in the world, most pressingly the analgesic morphine in many low and middle-income countries. As a heuristic device, ‘access’ has been the dominant way through which global health literatures have understood and tried to address this latter concern. Articles covering regions such as the Pacific, Mexico, India, Zimbabwe, and Sub-Saharan Africa more broadly use this relatively uncomplicated framing to describe the plight of patients in healthcare settings where morphine is not commonly prescribed. Indeed, even when authors draw attention to the imbalances in opioid research (92% conducted into ‘misuse’ and ‘abuse’ and only 8% into opioid ‘access’) it is this terminology that demarcates the problem. Yet behind a lack of ‘access’ lie a multitude of factors that disrupt the assumed demand implicit therein. For, as the anthropology of drugs has displayed, these are objects inconsistent between diverse geographical, temporal, or institutional settings. Analgesics and their representations are conditioned by historical and legislative trajectories, public and professional narratives, clinical and lay practices of pain and relief. In this paper, I draw on ethnographic fieldwork undertaken in a north-Indian cancer hospital to display the complexities so often collapsed within global health into the simple terminology of ‘access’.