Improving Availability of and Access to Opioids in Colombia: Description and Preliminary Results of an Action Plan for the Country

Abstract

Latin America consumes less than 2.7% of the morphine in the world, as reported by the governments to the International Narcotics Control Board. Methods to improve access to opioids for the treatment of pain have been developed by the Pain & Policy Studies Group (PPSG), a World Health Organization Collaborating Center at the University of Wisconsin. This article describes the preparation and implementation of an action plan in Colombia as a part of an international fellowship program on opioid policy developed by the PPSG and funded by the Open Society Institute. The action plan for Colombia included three steps: 1) a survey of regulators and health care providers to identify the current situation and their perceptions of opioid availability in the regions of the country; 2) a workshop with representatives of the Ministry of Health, the national and state competent authorities, pain and palliative care physicians, and international leaders; and 3) implementation workshops at the local level throughout the country. For the survey, response rates of 47% and 96% were registered among physicians and competent authorities, respectively. The survey identified significant regional differences in perceived opioid availability between physicians and regulators. Focus group discussions during the workshop identified several reasons leading to limited availability of opioids in the country, including deficiencies in the procurement process, insufficient human resources, excessive bureaucratic tasks, insufficient number of pharmacies authorized to dispense controlled medications in the country, lack of training in the health care professions, and overly restrictive laws and regulations governing opioid availability. The third step of the action plan has not been implemented. Additional and continuous monitoring needs to be implemented to measure the progress of this project.

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

“…Within the capital city region, Bogota, morphine was inconsistently available. In addition, there was poor distribution of the morphine supply from the warehouses in Bogota to pharmacies in the 32 states [35] because regional drug control authorities as well as pharmacies and hospitals in the states were not requesting morphine from the National Drug Control Authority at the Ministry of Health.…”

“…This was because insurance companies did not pay for them, and many patients could not pay for them out of pocket. Poor accessibility of opioids in hospitals and pharmacies because of limited hours for dispensing opioids was another identified factor [35]. A second activity to address the distribution and demand issue was a national opioid availability workshop held in 2007 to jointly review with healthcare providers and regulators the barriers and identify possible solutions and the steps needed to overcome those barriers.…”

Disponibilidad y barreras para el acceso a opioides en Colombia: experiencia de una institución universitaria

“…Al correlacionar el tipo de barrera enfrentado por el paciente para acceder al medicamento con el tiempo de entrega, se encontró que las barreras que más se asocian con retraso en la entrega del medicamento están dadas por problemas en el sitio de entrega y la calidad de la información suministrada (figura 1). lo que coincide con barreras previas reportadas por prestadores de salud [5] e información errónea sobre los medicamentos incluidos en el Plan Obligatorio de Salud. Sería deseable informar a las diferentes aseguradoras sobre los datos encontrados en el presente estudio para optimizar sus procesos de atención.…”

“…El consumo de morfina ha sido usado por muchos años como un indicador general del alivio del dolor de los países [5]. El promedio global de consumo se encuentra en 5,98 mg per cápita, mientras que en Colombia es de 1,09 mg per cápita [6].…”

Problemas y decisiones al final de la vida en pacientes con enfermedad en etapa terminal

“…Hay muy pocos especialistas en cuidado paliativo, y, aunque algunas instituciones ofrecen programas de atención domiciliaria, no cumplen con los criterios de una atención completa en cuidado paliativo (20). El uso de morfi na para el manejo del dolor es demasiado bajo, pues es inferior al promedio para América Latina y éste último corresponde a menos del 3 % del consumo mundial, lo cual es un indicador de pobre oferta de cuidado paliativo (21).…”