Opioid availability in latin america: The declaration of florianopolis

Abstract

Between March 27 and 29, 1994, a group of representatives of 32 palliative care programs from eight Latin American countries met under the auspices of the World Health Organization (WHO) Palliative Care Program for Latin America in Florianopolis, Brazil. The participants included physicians, nurses, psychologists, volunteers, drug regulators, hospital administrators, and representatives from the pharmaceutical industry. A comprehensive report by David Joranson (University of Wisconsin-Madison) was followed by a general discussion moderated by Jan Stjernsward, Chief of the Cancer Unit, World Health Organization, and by Eduardo Bruera, Coordinator of the WHO Cancer Pain and Palliative Care Program for Latin America. A number of issues related to opioid availability were identified and discussed. This declaration summarizes the main conclusions of the meeting. The attendants would like to encourage the widest possible distribution of this document.

Palliative Care in Brazil: A Challenge to the Health-Care System

“…This is a recurring concern, preventing palliative care from being implemented in health systems and may not be addressed without strongly confronting such issues. 24,25 The restricted access to opioids in Latin America has been denounced in the Declaration of Florianópolis, 26 constituting an important hindrance to a successful implementation of good palliative care programs, in addition to configuring a practice of legitimated abandonment imposed upon patients suffering from advanced and terminal diseases.…”

Prevalence and intensity of dyspnea, pain, and agitation among people dying with late stage dementia compared with people dying with advanced cancer: a single-center preliminary study in Brazil

“…Considering that patients were seen by a specialized palliative care team in a private hospital, these rates were probably underestimated, and did not reflect the "real world" in Brazil, where traditionally the access to opioids is limited. Although advances have been made since the World Health Organization meeting of experts aimed at improving cancer pain in Latin America, more than two decades ago (28), gaps in education, social equality, and public policies remain important barriers for effective cancer pain control in Brazil (29).…”

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

“…Los factores que dificultan el acceso a los opioides para uso médico incluyen una legislación restrictiva, la destinación insuficiente de recursos en las aseguradoras, la educación inadecuada del personal médico y la población general frente al uso adecuado de los medicamentos opioides, la insuficiencia del número de prestadores de cuidados paliativos y, en algunos países, los costos del medicamento [7][8][9][10][11][12].…”