Improving Access to Opioid Analgesics for Palliative Care in India

Joranson, David E.; Rajagopal, M. R.; Gilson, Aaron M.

doi:10.1016/s0885-3924(02)00458-x

Cited by 56 publications

(41 citation statements)

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“…Acquisition/cost A government-owned pharmaceutical company agreed to formulate, register, and distribute, free of charge, oral morphine solution to be supplied in concentrations of 5, 20, 30 and 50 mg/5 mL in 125-mL bottles (Ethiopia, 2010) 40 Domestically manufactured 10 mg of immediate-release morphine tablets were distributed, which were less than one-fifth of the cost of the morphine tablets previously available (Jordan, 2004) 41 A tax on oral morphine powder was eliminated, making it more affordable for hospices and palliative-care programs (Kenya, 2010) The first-ever shipment of morphine powder for the only hospice was procured, involving the development of record-keeping databases and written procedures on the safe-handling of morphine (Sierra Leone, 2008) 42 Domestic production of two formulations of immediate-release morphine tablets was established and import of sustained-release morphine was begun ( 40 Ministries of Public Health and Sanitation and of Medical Services developed the first-ever National Cancer Control Strategy, which includes pain relief and palliative care as one of seven key interventions and identifies the need for essential pain-relieving medicines (Kenya, 2011) 44 A National Association for Palliative Care was created to develop national palliative care policy, clinical tools to improve pain management, and sponsor trainings for health-care workers on palliative care and pain assessment (Nepal, 2009) A National Palliative Care Policy that recognizes the need for the government to ensure the availability of essential palliative care medicines, particularly oral opioids (e.g. morphine) and other related medicines at all levels of the health-care system, was created (Rwanda, 2010) (b) Guidelines for medication distribution State Health Secretary-appointed task force changed policy so that approved palliative-care programs would be exempt from a state rule requiring a "drug license" to dispense morphine, enabling the development of 3 times as many palliative care clinics stocking oral morphine for patients in rural and remote areas (India, 1999) 45 Guidelines to clarify requirements for transporting opioids from the distributor to health facilities and also between various health-care institutions were developed, encouraging a secure flow of opioids through the supply system for medical purposes (Jamaica, 2011) MoH developed a "Policy for Patient Access, and the Safe Management of Controlled Drugs," including guidelines for distributing controlled drugs in both public and private sectors (Jamaica, 2010) 46 (c) Prescribing laws MoH Decree changed law to (1) lengthen the maximum duration of prescribing opioids from 3 to 7 days;…”

Section: Domainsmentioning

confidence: 99%

Multivariate analysis of countries’ government and health-care system influences on opioid availability for cancer pain relief and palliative care: More than a function of human development

et al. 2012

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Study findings demonstrate that a limited number of predictor variables characterizing a country's government and health-care system infrastructure can explain its opioid consumption level, with the greatest influence being very high Human Development Index. However, Human Development Index is not the most policy-relevant factor, and this finding should be reconciled against the reality that many countries with low or medium Human Development Index have succeeded in creating and sustaining a health-care system to strengthen cancer pain care and palliative care, including through the appropriate use of essential prescription opioids.

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Section: Domainsmentioning

confidence: 99%

Multivariate analysis of countries’ government and health-care system influences on opioid availability for cancer pain relief and palliative care: More than a function of human development

et al. 2012

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“…Examples of recent initiatives include the WHO Access to Controlled Medicines Program [9], the Global Access to Pain Relief Initiative [24], Human Rights Watch reports focused on pain relief and palliative care [25][26][27], and the Drug Control and Access to Medicines Consortium [28]. Under the leadership and guidance of the Pain & Policy Studies Group (PPSG), important progress to improve opioid availability has been made in India [29], Italy [30], and Romania [31]. This work evolved into a multi-country initiative aimed at increasing the rate of improvements to opioid availability in countries.…”

Section: Initiatives To Improve Opioid Availability and Accessibilitymentioning

confidence: 99%

Improving the availability and accessibility of opioids for the treatment of pain: The International Pain Policy Fellowship

Bošnjak

Maurer

Ryan

et al. 2011

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Opioid analgesics are simultaneously indispensable medicines for the treatment of moderate to severe pain and are harmful when abused. The challenge for governments is to balance the obligation to prevent diversion, trafficking, and abuse of opioids with the equally important obligation to ensure their availability and accessibility for the relief of pain and suffering. Over the last 30 years, significant progress has been made toward improving access to opioids as measured by increasing global medical opioid consumption. However, this progress is marked by ongoing large disparities among countries, with most increases in medical opioid consumption attributed to high-income countries, not low- and middle-income countries (LMICs). The International Pain Policy Fellowship (IPPF) was developed by the Pain & Policy Studies Group, with the central goal of developing national leaders from LMICs and empowering them to improve availability and accessibility of opioids for the treatment of pain. To date, two classes of fellows have been selected, representing 17 fellows from 15 countries. Progress achieved by the leadership of three fellows from Sierra Leone, Colombia, and Serbia is highlighted in this paper. The fellows from each country were successful at initiating collaboration with relevant governmental bodies, national authorities, and professional societies, which resulted in a new supply of oral opioids in Sierra Leone and Serbia, and improvements in the distribution of already available opioids in Colombia. All fellows were instrumental in facilitating evaluation of national policy. The IPPF program empowers fellows with the necessary knowledge, skills, and guidance to improve the availability and accessibility of opioids for the treatment of pain.

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“…[32][33][34] The Pain and Policy Studies Group (a World Health Organization collaborating center) has developed guidelines that can be used by governments and health professionals to assess the national opioids control policies; the administration of these policies must ensure the availability of opioid analgesics. 35 Countries should urgently examine their drug control policies to assess the legal and other barriers to opioid availability.…”

Section: Palliative Care and Opioids Availability In The Me Countriesmentioning

confidence: 99%

Opioids for Cancer Pain in the Middle Eastern Countries

Daher

2011

Journal of Pediatric Hematology/Oncology

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Cancer is an increasing problem in the Middle Eastern (ME) countries. It is the fourth leading cause of death in this region. At present, resources for cancer control in the ME countries as a whole are not only inadequate but directed almost exclusively to treatment. In the majority of countries of this region, cancer is generally diagnosed when it is at a relatively advanced stage. Pain is prevalent among people who have cancer, and is one of the most feared and burdensome symptoms. Pain negatively affects the quality of life of patients with cancer. Inadequate and inappropriate pain management of patients who experienced cancer pain has been documented in several studies and this is possibly due to insufficient understanding of pain assessment and management. Middle Eastern countries include a wide range of economically diverse countries, from technically advanced countries with high level cancer care to countries with little or no cancer treatment capabilities. There are large differences in population size, wealth and health expenditure. Palliative care (PC) is an urgent humanitarian need worldwide for people with cancer and other chronic fatal diseases; relieving pain and suffering is an essential part of PC. The need for improved palliative care in ME countries is great. Of 58 million people who die every year, 45 million die in developing countries. An estimated 60% (27 million) of these people in developing countries would benefit from palliative care, and this number is growing as chronic diseases such as cancer rise rapidly. From the situation analysis of palliative care in the ME countries, suggesting that pain relief is insufficient, improvements in palliative care delivery are a high priority.We reviewed the situation of pain management and pain control in Lebanon and the ME countries, the barriers that are present, and we propose the priorities and a reform for an integrated approach to address the problem of under-treated pain at all levels:

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Improving Access to Opioid Analgesics for Palliative Care in India

Cited by 56 publications

References 5 publications

Multivariate analysis of countries’ government and health-care system influences on opioid availability for cancer pain relief and palliative care: More than a function of human development

Multivariate analysis of countries’ government and health-care system influences on opioid availability for cancer pain relief and palliative care: More than a function of human development

Improving the availability and accessibility of opioids for the treatment of pain: The International Pain Policy Fellowship

Opioids for Cancer Pain in the Middle Eastern Countries

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