Page 0100

PALLIATIVE CARE

PALLIATIVE CARE AND ACCESS TO

MEDICATIONS FOR PAIN

TREATMENT

CLAIRE MORRIS, INTERNATIONAL ADVOCACY AND PROGRAMMES MANAGER, WORLDWIDE PALLIATIVE

CARE ALLIANCE, LONDON, UK

The World Health Organization (WHO) recommends that controlled, essential medications are

absolutely necessary for treatment for moderate to severe pain for people with cancer1. Yet

millions of people worldwide with life-limiting conditions are living and dying in pain and

distress due to the lack of availability and accessibility of these medications. WHO estimates

that 5.5 million people with cancer suffer from moderate to severe pain2. The disparity in the

availability and consumption of treatment for pain is stark with an estimated 80% of the

world’s population living in countries with low or no access to pain treatment for moderate to

severe pain3. More than 99% of untreated deaths in pain from cancer and HIV are in low- and

middle-income countries4. Access to appropriate pain treatment for children is a particularly

challenging issue.

alliative care is a patient-centred approach that availability of opioids for medicinal purposes and this has been

P improves the quality of life of adults and children living

with life-limiting conditions, including cancer. It

addresses their physical, psychological, social and economic,

repeatedly reiterated by the World Health Organization10 and

the International Narcotics Control Board11 as well as non-

governmental organizations. It is clearly acknowledged that

legal and spiritual problems from the point of diagnosis the role of governments is to ensure balance in national

throughout the life course5,6. Palliative care is not just about policies on controlled substances to ensure that people in

the treatment of physical pain but this is a core element of it; need of medicinal care, including pain treatment, can access

and access to the medication needed to treat moderate to the medications they need, while addressing issues of misuse

severe pain, particularly opioid analgesics, is one of the major and diversion12.

practical barriers to delivering quality palliative care However, barriers and over-regulatory policies remain. A

worldwide. report published by the European Society for Medical

Yet while the barriers are numerous, initiatives around the Oncology (ESMO) and the European Association of Palliative

world are seeing an increase in access to palliative care Care on regulatory barriers for cancer pain in Europe, clearly

services, including pain treatment. The percentage of highlighted the “poorly-considered regulations and

countries with at least one palliative care service rose from deficiencies in public policy” across Europe, and particularly in

49% in 20067 to 58% in 20118. Eastern Europe13. The regulatory barriers included the need

for a permit (or to be registered) to receive opioid

The barriers prescriptions, the need for a physician to have a special permit,

Multiple barriers have been identified which affect the requirements of duplicate or triplicate prescriptions,

availability and accessibility of pain treatment for people living restrictions in prescription and daily dose limits, limitations on

with life-limiting illnesses. These include: where opioids can be dispensed and inadequate provision for

opioid prescribing in emergency situations14. All of these

Excessive regulatory policies and restrictions policies create barriers that prevent people from accessing the

The issue of overly excessive regulatory policies and quality clinical care that they need.

restrictions is one of the major barriers to the availability of These excessive regulations, policies and restrictions are by

access to pain treatment worldwide. The 1961 Single no means limited to Europe. The African Palliative Care

Convention on Narcotic Drugs9 highlighted the need for the Association has identified supply and legislation as two of the

98 CANCER CONTROL 2013

Index

  1. CANCER CONTROL 2013
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