BackgroundAlmost five decades ago, governments around the world adopted the 1961 Single Convention on Narcotic Drugs which, in addition to addressing the control of illicit narcotics, obligated countries to work towards universal access to the narcotic drugs necessary to alleviate pain and suffering. Yet, despite the existence of inexpensive and effective pain relief medicines, tens of millions of people around the world continue to suffer from moderate to severe pain each year without treatment.DiscussionSignificant barriers to effective pain treatment include: the failure of many governments to put in place functioning drug supply systems; the failure to enact policies on pain treatment and palliative care; poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment. These barriers can be understood not only as a failure to provide essential medicines and relieve suffering but also as human rights abuses.SummaryAccording to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment.
The concept of access to pain management as a human right has gained increasing currency in recent years. Commencing as individual advocacy, it was later embraced by the disciplines of pain medicine and palliative care and by mainstream human rights organizations. Today, United Nations and regional human rights bodies have accepted the concept and incorporated it into key human rights reports, reviews, and standards. We review the foundations in law of this right and the obligations that flow from it to governments. We analyze the nature and content of the obligation in the context of acute, chronic nonmalignant and cancer pain. Finally, we examine this right in light of the twin crises of inadequate access to pain management and the opioid crisis in the United States and other nations.
PurposeMore than 1 million new occurrences of cancer are diagnosed in India
annually. Among patients with cancer, pain is a common and persistent
symptom of the disease and its treatment. However, few studies to date have
evaluated the prevalence of pain and the adequacy of pain management in
Indian hospitals. This cross-sectional study aimed to assess the prevalence
and sociodemographic patterns of cancer pain and pain management among a
sample of inpatients and newly registered outpatients at four large regional
cancer centers in India.MethodsA sample of 1,600 patients with cancer who were current inpatients or newly
registered outpatients were recruited and administered a questionnaire that
was based on the Brief Pain Inventory. The survey tool included questions on
demographics, medical history, and extent of clinical pain experienced. In
addition, a pain management index score was created to link the severity of
cancer pain with medication prescribed to treat it.ResultsA total of 88% of patients reported pain in the past 7 days, and
approximately 60% reported that their worst pain was severe. Several
demographic and medical characteristics of the study population predicted
severe pain, including the following: lower educational level, outpatient
status, and debt incurred as a result of illness. A total of 67% of patients
were inadequately treated with analgesics. Inadequate pain management was
associated with both treatment hospital and patient type, and patients who
reported debt as a result of their illness were more likely to have
inadequate pain management.ConclusionA majority of Indian patients with cancer experience significant pain and
receive inadequate pain management. Improvement of pain management for
Indian patients with cancer is needed urgently.
Development of human rights standards in relation to palliative care has been most notable in the context of the right to health, freedom from torture and ill treatment, and the rights of older persons. More work is needed in the context of the rights of children, and human rights treaty bodies are still not consistently addressing state obligations with regards to palliative care.
The lack of adequate access to opioids in India as analgesics and for agonist therapies, forces millions to live with severe unalleviated pain, or languish with suffering associated with drug dependence. Although India is a major opium exporter, the excessively prohibitive 1985 narcotics law formulated to control harmful use of drugs, impeded the availability and access to opioids for medical and scientific purposes. Amendment of this law in 2014 established a new national regulatory framework for improved access to essential opioid analgesics. This article reflects on key elements and processes that led to this landmark achievement. Unlike quick timelines associated with effecting policy reforms for law enforcement, realizing the 2014 drug policy change primarily to mitigate human suffering, was a 22-year-long process. The most exacting challenges included recognizing the multilayered complexities of the prior policy framework and understanding their adverse impact on field practices to chart an appropriate and viable path for reform. The evolution of an informal civil society movement involving health care professionals, lawyers, media, policy analysts, government officials, and the public was pivotal in addressing these challenges and garnering momentum for reform. The success of the effort for improving access to opioid medications was underpinned by a three-pronged strategy of 1) persuading the executive arm of the government to take interim enabling measures; 2) leveraging judicial intervention through public interest litigation; and 3) crafting a viable policy document for legislative approval and implementation. We hope our findings are useful for realizing drug policy reforms, given the current transformed global policy mandates emphasizing humanitarian, healthcare, and quality-of-life considerations.
There is significant need for palliative care in Senegal. Training of health care workers and ensuring availability of relevant medications should be prioritized.
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