Islamabad: While illicit narcotics including methamphetamine and hashish remain widely available on Pakistan’s streets, hospitals across the country have run out of legally approved pain medicines, including morphine and fentanyl, leaving thousands of dying cancer patients, including children, without effective relief after regulatory delays halted their production.
The shortage has affected some of the country’s leading cancer treatment centres, including the Indus Hospital and Health Network Karachi, Aga Khan University Hospital, Tabba Heart Institute, Liaquat National Hospital, South City Hospital, Dr Ziauddin Hospitals, Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore, and several other public and private hospitals, forcing doctors to rely on weaker painkillers that specialists say cannot adequately control the severe pain experienced by patients with advanced cancer.
Hospital pharmacists and pharmaceutical industry officials blamed the crisis on prolonged delays in the approval of annual quotas for controlled narcotic Active Pharmaceutical Ingredients (APIs), import authorisations and other regulatory requirements governing opioid medicines. They warned that unless approvals are expedited, fresh supplies of morphine and fentanyl are unlikely to reach hospitals before October or November.
Arif Arain, Senior Pharmacist at the Indus Hospital and Health Network Karachi, confirmed that the hospital had already exhausted its stocks of injectable morphine and injectable 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 many cancer patients receiving palliative care, and there is no equally effective substitute for severe cancer pain,” he said.
Morphine and fentanyl are considered the gold standard for treating moderate to severe cancer pain and are recommended by the World Health Organization for patients requiring palliative and end-of-life care.
Unlike commonly used analgesics such as paracetamol, diclofenac, ibuprofen and other non-opioid painkillers, these medicines act directly on opioid receptors in the brain and spinal cord to control severe, persistent pain caused by advanced cancers involving bones, nerves and internal organs.
Cancer specialists say patients with metastatic breast cancer, advanced head and neck cancers, pancreatic cancer, bone tumours and childhood malignancies such as neuroblastoma, osteosarcoma and relapsed leukaemia often develop pain so severe that ordinary painkillers provide little or no relief. Without strong opioids, many patients remain in constant agony, unable to sleep, eat or undergo treatment comfortably.
The mother of an eight-year-old child suffering from advanced neuroblastoma said doctors were now using ‘ordinary’ pain medicines because morphine and fentanyl were unavailable, but they were failing to control her son’s pain.
“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 framework, companies manufacturing opioid medicines cannot import narcotic APIs until annual quotas are allocated by the competent authorities, followed by import permits and other regulatory clearances required under the country’s controlled substances laws.
Industry representatives said the process had become increasingly slow because of multiple layers of administrative scrutiny involving quota allocation, import authorisations and regulatory approvals, disrupting production of these essential medicines. They warned that even if approvals are granted immediately, hospitals may not receive fresh supplies before October or November.
One senior hospital pharmacist described the situation as deeply ironic. “Heroin, crystal methamphetamine, hashish, opium and other illicit narcotics are readily available on Pakistani streets, yet hospitals cannot obtain legally manufactured morphine for dying cancer patients. There is something fundamentally wrong with a system that allows illegal drugs to flourish while patients in unbearable pain are denied essential medicines,” he said.
The shortage comes as the World Health Organization warns that palliative care remains 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 percent receive it. Pakistan recorded an estimated 185,748 new cancer cases and 118,631 cancer deaths in 2022, underscoring the growing need for effective pain management and supportive care.
The WHO says palliative care is an essential component of comprehensive cancer treatment and should be integrated alongside prevention, early diagnosis, treatment, rehabilitation and survivorship services. However, limited access to opioid medicines, shortages of trained personnel and weak palliative care services continue to leave millions of patients worldwide 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 certainly examine the matter if shortages have occurred,” the official said.
Healthcare experts warned that unless the regulatory bottlenecks delaying quota allocation, import approvals and manufacturing of controlled medicines are resolved urgently, thousands of Pakistan’s cancer patients will continue to suffer avoidable pain despite the availability of internationally recognised medicines capable of providing effective relief.
Ends