Access to controlled medication;opioid avilability

[Guest guest]

Hello Dr Mangesh,

The World Health Organization (WHO) recommends a basic three-part strategy for developing a cancer pain relief program in a country: (a) the national (or state) government health and regulatory authorities should establish and support a policy that makes cancer pain relief a high priority in the health care system.

( the public, policymakers, and regulators should be informed that cancer pain can be relieved; health care professionals should be trained to manage cancer pain using the three-step ladder; and

© analgesics, including opioids such as morphine, should be made available.

There is little or no use of morphine in nearly half of the countries in the world. Almost all morphine is consumed in developed countries. Trends in morphine consumption for medical purposes vary greatly, with recent increases in many countries and decreases in some others. The consumption of morphine for medical purposes throughout the world was low and stable for many years before 1984, when the WHO cancer pain relief program began.

Barriers to Opioid Availability-

International health and drug regulatory authorities have recognized that opioid analgesics are not sufficiently available for the treatment of cancer pain in many places throughout the world.

Number of economic and historic factors contribute to the current lack of oral opioid availability. Many countries do not have the resources and health care infrastructure to produce and distribute medicines. Traditionally, the treatment of pain has not been as high a priority as the treatment of disease. Injectable morphine has long been recognized as a potent analgesic, but the broader realization that oral morphine is also very effective is more recent. Although the international narcotics control treaty has recognized for many years that opioids are indispensable in the management of pain, some countries have drug laws that prohibit or restrict the availability and medical use of opioids. In addition, misunderstanding and fear of addiction impede the rational use of opioids in cancer pain relief throughout the world.

Accessing barriers-

A suggested first step to improve the availability of opioids in a country is for a small group of knowledgeable and committed professionals to take responsibility for developing an action plan. A logical place to begin is to identify the barriers that exist in the national drug distribution system. The specific reasons for the poor availability of opioids may vary from country to country and from place to place. These barriers as well as their underlying causes should be carefully identified so that the limited time and energy of health care professionals can be focused efficiently on the actions that are necessary to correct the situation.

Developing an Action Plan -

After identifying barriers to opioid availability, an action plan must be developed to remove them. In general, this involves deciding (a) which government agencies or industries should be contacted, ( with whom contact should be made, © who are the best people to make these contacts, and (d) what kind of preparation is necessary. These preparations can be aided by a new resource from the WHO Expert Committee on Cancer Pain Relief and Active Supportive Care. which has prepared a Guide to opoid avilability

.. The purpose of the Guide is to assist health care workers and national regulators in their efforts to improve the availability of essential drugs, including the opioid analgesics that are preferred for cancer pain management..

Kindly read the guide to opioid availability at following linkà

http://www.painpolicy.wisc.edu/publicat/cprguid.htm

Regards,

Dr Deepali