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Cancer groups from around the world say millions of cancer patients are not able to obtain painkillers because of laws designed to fight drug abuse.

A global survey released by the European Society for Medical Oncology asked doctors in developing countries about patients’ access to painkillers including codeine and morphine, the Associated Press reports.

It is “catastrophically difficult” in many countries to relieve cancer pain, according to study author Nathan Cherny. The report, published in the Annals of Oncology, found more than half of the world’s population resides in countries where regulations designed to reduce drug abuse can leave cancer patients without access to opioids to treat cancer pain.

The European Society for Medical Oncology said governments must improve access to these medicines. “When one considers that effective treatments are cheap and available, untreated cancer pain and its horrendous consequences for patients and their families is a scandal of global proportions,” Cherny said in a news release. “This is a tragedy born out of good intentions. When opioids are over-regulated, the precautionary measures to prevent abuse and diversion are excessive and impair the ability of healthcare systems to relieve real suffering.”

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