Addressing The Barriers Related With Opioid Therapy For Management of Chronic Pain in India

Dureja, G. P.; Jain, Paramanand N.; Joshi, Meera; Saxena, Ashok Kumar; Das, Gautam; Ahdal, Jaishid; Narang, Prashant

doi:10.2217/pmt-2016-0064

Cited by 11 publications

(9 citation statements)

References 112 publications

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“…[43] This finding has been replicated internationally also. [12161719204445] In a multisite survey on Asian medical practitioners ( n = 463), medical school training on opioid use was considered inadequate by 30.5% of medical practitioners, and 55.9% indicated ≤10 h of continuing medical education on this subject. [44] In our study, having received formal pain management training was associated with a greater likelihood of defining addiction accurately.…”

Section: Discussionmentioning

confidence: 99%

A cross-sectional web-based survey of medical practitioners in India to assess their knowledge, attitude, prescription practices, and barriers toward opioid analgesic prescriptions

Singh¹,

Prasad²,

Bhatnagar³

et al. 2019

Indian J Palliat Care

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Context:Inadequate training of medical practitioners is a key factor responsible for inappropriate use of opioid analgesics.Aims:We assessed the current knowledge, attitude, prescribing practices, and barriers perceived by the Indian medical practitioners in three tertiary care hospitals toward the use of opioid analgesics.Subjects and Methods:Web-based survey of registered medical practitioner employed at three chosen tertiary health care institutions in New Delhi.Statistical Analysis Used:Descriptive analysis of survey responses was carried out. Comparative analysis was done using Chi-square test, independent samples t-test, and Pearson correlation coefficient.Results:The response rate was 10.4% (n = 308). Two-thirds of the participants (61.7%) had never received formal pain management training, and 86.7% participants would like further training. Most participants (71.1%) agreed that opioids should be prescribed in cancer pain, while 26.3% agreed that opioids should be prescribed in noncancer pain. Half of the participants agreed that SOS (if necessary) dosing schedule (48.4%), low dosage (61.7%), and short duration of use (51.4%) could decrease the harmful effect of opioids. Lack of information about opioid-related policies and addiction potential were identified as the most common barriers to prescribing opioids. Those seeing more patients with chronic noncancer pain come across opioid misuse and diversion more often (P = 0.02). Those who understood addiction were more likely to agree that patients of chronic cancer pain with substance use disorders should be prescribed opioid analgesics (P < 0.01).Conclusions:Indian medical practitioners felt the need for formal pain management training. There is a lack of consensus on how to manage the pain using opioid analgesics. Tough regulations on medical and scientific use of opioids are the most commonly reported barrier to prescribing them.

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Section: Discussionmentioning

confidence: 99%

A cross-sectional web-based survey of medical practitioners in India to assess their knowledge, attitude, prescription practices, and barriers toward opioid analgesic prescriptions

Singh¹,

Prasad²,

Bhatnagar³

et al. 2019

Indian J Palliat Care

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“…Africa [23], Latin America [24] and South Asia [25]. A review of these documents highlighted that as Dr Humphreys feared, the "clear blue waters" are being muddied by the same tactics that were used 20 years ago in developed economies.…”

Section: Guideline Reviewmentioning

confidence: 99%

Warning from Canada: Latin America, South Africa and India may face an opioid epidemic in the coming years

Furlan¹,

Harvey²,

Chadha³

2020

Journal of Global Health

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“…A well-defined curriculum and educational program is needed to ensure uniform training. [ 44 ] While Kerala is a global training hub, most of the other states have a paucity of educational programs and palliative care services. [ 9 ] Current undergraduate medical teaching does not include the WHO Step Ladder[ 45 ] and use of opioids in providing pain relief.…”

Section: Iversity In H Ealth-care mentioning

confidence: 99%

Challenges of using methadone in the Indian pain and palliative care practice

Viswanath

Palat

Chary

et al. 2018

Indian J Palliat Care

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Palliative care providers across India lobbied to gain access to methadone for pain relief and this has finally been achieved. Palliative care activists will count on the numerous strengths for introducing methadone in India, including the various national and state government initiatives that have been introduced recognizing the importance of palliative care as a specialty in addition to improving opioid accessibility and training. Adding to the support are the Non-Governmental Organizations (NGOs), the medical fraternity and the international interactive and innovative programs such as the Project Extension for Community Health Outcome. As compelling as the need for methadone is, many challenges await. This article outlines the challenges of procuring methadone and also discusses the challenges specific to methadone. Balancing the availability and diversion in a setting of opioid phobia, implementing the amended laws to improve availability and accessibility in a country with diverse health-care practices are the major challenges in implementing methadone for relief of pain. The unique pharmacology of the drug requires meticulous patient selection, vigilant monitoring, and excellent communication and collaboration with a multidisciplinary team and caregivers. The psychological acceptance of the patient, the professional training of the team and the place where care is provided are also challenges which need to be overcome. These challenges could well be the catalyst for a more diligent and vigilant approach to opioid prescribing practices. Start low, go slow could well be the way forward with caregiver education to prescribe methadone safely in the Indian palliative care setting.

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Addressing The Barriers Related With Opioid Therapy For Management of Chronic Pain in India

Cited by 11 publications

References 112 publications

A cross-sectional web-based survey of medical practitioners in India to assess their knowledge, attitude, prescription practices, and barriers toward opioid analgesic prescriptions

A cross-sectional web-based survey of medical practitioners in India to assess their knowledge, attitude, prescription practices, and barriers toward opioid analgesic prescriptions

Warning from Canada: Latin America, South Africa and India may face an opioid epidemic in the coming years

Challenges of using methadone in the Indian pain and palliative care practice

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