Karachi: More than 3,000 morphine ampoules expired unused at the National Institute of Cardiovascular Diseases (NICVD) as patients across Pakistan struggle to obtain the medicine for severe pain relief, Vitals News learnt on Monday.
Morphine is a powerful opioid used to relieve severe pain, particularly in children and adults with cancer whose disease can cause unbearable suffering. It is also used when clinically appropriate for severe pain following trauma and serious injuries, and can help relieve distressing breathlessness in some patients receiving palliative care.
NICVD’s administration acknowledged the expired stock but rejected reports that it would cause a loss of more than Rs8 million to the public exchequer. In a clarification issued on Monday, spokesperson Abdul Nasir said the supplier would replace the expired ampoules with fresh stock without any additional payment once the required inspections and legal procedures were completed.
The clarification, however, did not explain why such a large quantity remained unused until expiry or what steps were taken beforehand to prevent it. It also gave no definite date for returning the expired medicine or receiving its replacement.
According to documentary details provided to Vitals News, pharmacist Talha Mehboob Khan wrote to Assistant Manager Pharmacy Services Saima Saleem on December 24, 2025, stating that 3,191 morphine ampoules remained in the hospital’s narcotics cabinet. Their expiry date was December 30, just six days later.
The letter recorded the use of 2,809 ampoules between October 2023 and November 2025, with the remaining stock secured in the cabinet and its key handed over to the relevant official. About 53 percent of the total allocation of 6,000 ampoules therefore remained unused days before its expiry.
The stock remained at NICVD during a period when access to injectable morphine was already a documented problem elsewhere. An August 2025 report in The News International found that Aga Khan University Hospital had exhausted its injectable morphine supplies despite the needs of patients in severe pain, including children and older people.
The same report said Shaukat Khanum Memorial Cancer Hospital in Lahore and Indus Hospital in Karachi still had morphine but stressed the need for uninterrupted, year-round supplies. The concern was that annual allocations alone could not guarantee continued access for patients requiring ongoing pain relief.
In April 2022, Dr Shamvil Ashraf had told The News that obtaining the necessary permissions and allocated supplies could take six months to a year. Dr Faisal Sultan had also confirmed difficulties faced by Shaukat Khanum because of the lengthy approval process.
Paediatric oncologists had warned in February 2022 that children with cancer endured severe pain day and night when morphine was unavailable. WHO guidance allows its use under appropriate medical supervision for children with life-limiting conditions and in end-of-life care.
NICVD said morphine was a legally controlled narcotic whose procurement, supply, storage, use and return required official permissions and compliance with specific regulations. The administration said its injections were supplied through imported shipments and could not be handled like ordinary medicines.
Expired ampoules could not be returned immediately, it said, because inspection by the drug inspector, verification and other legal procedures had to be completed first. Once those requirements were met, the supplier would provide replacement stock free of charge, avoiding any additional financial burden on the hospital.
The administration also said it maintained an inventory management system, stock registers and checks covering medicine receipt, storage, issue and use. Controlled drugs such as morphine, it said, were subject to additional record-keeping and accountability requirements.
However, its statement did not explain how thousands of ampoules reached expiry despite those safeguards, or whether any lawful arrangement to supply facilities facing shortages had been explored. The promised replacement addresses the administration’s position on financial loss, but leaves unanswered why the existing medicine could not be used for patients before it expired.