Opioid Accessibility for Palliative Care in Nepal: A Review of Achievement and Remaining Challenges.

This study aimed to explore current opioid availability and accessibility for palliative care (PC) practice in Nepal. A narrative review was conducted by performing literature searches in electronic databases, grey literature, policy documents, and pharmaceutical websites. This was supplemented by utilising the authors' expertise and experience in this field. Six different opioids are available in Nepal, including oral immediate and modified-release morphine formulations. Morphine is produced and distributed by only one manufacturer, which imports all raw materials from Europe. Access to morphine in rural areas is poor, with rural-level healthcare centres rarely stocking morphine, particularly in PC formulations. Fentanyl transdermal (TD) patch and methadone syrup are available in Nepal but are imported. The Fentanyl TD patch is extremely expensive, and methadone syrup is only available for the management of addiction. While opioid availability has increased in Nepal, there is a need to improve opioid accessibility for PC services, particularly in rural areas. Several approaches are explored in this review.