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

Abstract

Asia is a heterogeneous region with substantial variability in economic, social and palliative care development. While the global consumption of opioids has increased, the consumption in most Asian countries has not increased at the same rate. This is the first comprehensive study of opioid availability and accessibility for cancer patients in Asia. Data are reported on the availability and accessibility of opioids for the management of cancer pain in 20 of 28 countries. The countries in the report represent 2515 million of the region's 2612 million people (96%). With the exception of Japan and South Korea, opioid availability continues to be low throughout most of Asia. Formulary deficiencies are severe in several countries, in particular Bangladesh, Myanmar, Afghanistan, Kazakhstan and Laos. Even when opioids are on formulary, they are often unavailable, particularly in the same countries. Access is significantly impaired by widespread over-regulation that continues to be pervasive across the region.

Recommendations to support nurses and improve the delivery of oncology and palliative care in India

“…[4849505152] Progress has been made to improve opioid availability within India, but many patients with cancer still suffer in avoidable pain. [535455] For example, the palliative care department at SICH has made significant effort to procure morphine and make the medication available to patients, especially those seen in the palliative care department.…”

Effective Canadian policy to reduce harms from prescription opioids: learning from past failures

“…19 Although opioids are generally available and concerns about undertreatment of pain exist, alternative approaches and tools for the treatment of chronic pain are emphasized, with substantially lower quantities of opioids prescribed. [46][47][48] Overall, medical system culture -including less commercialization in health care and less influence from the pharmaceutical industry and advertising -has been found to play a role in differentiating levels of opioid use in different contexts: some practices rely less on pharmacotherapy to deal with pain. 49,50 Consequently, opioid-related harms as observed in North America are considered uncommon elsewhere (e.g., in Europe).…”

Change Pain: Ever Evolving—An Update for 2016

“…A significant barrier to more effective pain relief continues to be a reluctance or concern to prescribe opioid analgesics. In many parts of the world, opioid use is virtually nonexistent, even for the treatment of severe to very severe pain at end of life [13, 14]. Even in nations where opioids are more readily available and accepted, some prescribers may hesitate to utilize them, even when they are medically appropriate, for fear of fueling opioid misuse and abuse or concern about legal liability [15].…”