Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Latin America and the Caribbean: a report from the Global Opioid Policy Initiative (GOPI)

Abstract

The nations of the Caribbean, Central America and South America form a heterogeneous region with substantial variability in economic, social and palliative care development. Palliative care provision is at varied stages of development throughout the region. The consumption of opioids in Latin America and the Caribbean is variable with moderate levels of consumption by international standards (1-10 mg morphine equivalents/capita/year) observed in Argentine, Brazil, Chile, Colombia, Cuba, Mexico, Costa Rica, Uruguay and most of the Caribbean but relatively low levels of consumption in other countries particularly Guatemala, Honduras and Bolivia. Data for Latin American and Caribbean is reported on the availability and accessibility of opioids for the management of cancer pain in 24 of the 33 countries surveyed. The results of this survey are relevant to 560 million of the region's 595 million people (94%). Opioid availability continues to be low throughout most of Latin America and the Caribbean. While formularies in this region generally include all recommended morphine formulations, access is significantly impaired by widespread over-regulation that continues to be pervasive across the region.

The needs, models of care, interventions and outcomes of palliative care in the Caribbean: a systematic review of the evidence

“…Four studies reported data from Jamaica [32–35], three each from Barbados [27, 34, 35] and Cuba [29–31], two studies each from Trinidad and Tobago [34, 35], St Lucia [34, 35] and Grenada [28, 35] and one study reported from each of the following islands: Antigua and Barbuda, Montserrat, St Kitts and Nevis, St Vincent and the Grenadines [35], Anguilla, Dominica and the Dominican Republic [34] . Please refer to Table 4 to view the studies in detail.…”

“…Seven studies [27, 29–32, 34, 35] used quantitative methodological approaches, and cross sectional survey designs were utilized within these studies. One study used a mixed methods design with qualitative and quantitative components [33].…”

“…They also felt there is a lack of appropriate training in palliative care. Many practitioners were poorly informed as to what palliative care is or what it could offer.They also pointed out restrictive government policies over access to certain analgesics as a challenge to deliver adequate pain relief.Quantitative score:0.5Qualitative score:0.8Cleary et al [34] 2013AnguillaBarbadosDominicaDominican RepublicJamaicaSt LuciaTrinidad and TobagoTo determine formulary availability and regulatory barriers to accessibility of opioids for cancer pain in the Caribbean.Cross Sectional SurveyThe data were collected from physicians working in the field of palliative care. It was difficult to determine the number of participants who were from the Caribbean since the data from the Caribbean and Latin American were summated together.…”

Impact of Geographic Region on Benefit of Approved Anticancer Drugs Evaluated in International Phase III Clinical Trials

“…This finding may be explained by availability of effective, subsequent lines of therapy, which are probably less extensive in developing compared with developed countries. Furthermore, the overall quality of health care, especially of supportive and palliative therapy, may be lower in developing countries [25,26] and availability of such care has been shown to be associated with improved survival [4]. The increasing toxicity of new anticancer drugs is well established [20] and therefore effective palliative care is especially important as new drugs move from clinical trials to routine practice where their use in less selected patients would probably lead to a less favourable balance between benefit and harm [27].…”

ESMO gave me a chance to help make a difference: a personal reflection on the occasion of receiving the 2015 ESMO Award

“…This massive collaborative project, known as the Global Opioid Pain Initiative (GOPI), and the data derived from it, [17][18][19][20][21][22][23][24] set an international agenda to address problems of access, cost and regulatory barriers around the world, and placed ESMO squarely as a central participant in this critical global endeavour.…”