PPSG News Alerts
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The Pain and Policy Studies Group
(PPSG) would like to call your attention to two recent publications that may
be of interest in relation to state pain policies. For further information,
please contact Jody Jorenby, Communications Coordinator, jpjorenby@facstaff.wisc.edu,
608-263-5438.
1. Decade of progress. The February 2002 issue of the Journal of Pain and Symptom
Management describes a ten-year program of research, education, and policy development
to improve state medical board policies on the use of opioids for the treatment
of chronic cancer and non-cancer pain. The current article reviews each step
in the program and describes the extent to which states have adopted “Model
Guidelines for the Use of Controlled Substances for the Treatment of Pain.”
[http://www.fsmb.org] A number of recommendations
are made. The authors include David E. Joranson and Aaron M. Gilson of the PPSG,
and Dr. June L. Dahl and Dr. J. David Haddox who served as faculty for the PPSG
workshops for medical board members from 1996 to 1998. Last year the PPSG reported
two studies [http://www.medsch.wisc.edu/painpolicy/publicat/01jpsm/index.htm]
that showed positive and lasting changes in state medical board members’
understanding of the use of opioids for chronic pain. The work was supported
by the Robert Wood Johnson Foundation and Advocates for Children’s Pain
Relief. Go to the article at: http://www.medsch.wisc.edu/painpolicy/publicat/02jpsm1/index.htm.
2. Annual Review of state pain policies
for 2001. Also in February, the PPSG published a monograph (the Annual Review)
that presents and evaluates new state pain policies adopted in 2001. In 2001,
six policies were adopted in five states: Kentucky, Missouri, Tennessee, Texas,
and West Virginia. These included three medical board guidelines and one pharmacy
board policy statement modeled after the “Model Guidelines for the Use
of Controlled Substances for the Treatment of Pain”, one joint policy
statement about end-of-life care emphasizing the need for interdisciplinary
collaboration, and one Intractable Pain Treatment Act (IPTA). The Annual Review
concludes that the Model Guidelines continue to serve as a good foundation for
balanced policy from state licensing boards, while IPTAs lack balance. The authors
are the staff members of the PPSG. The work was supported by the Robert Wood
Johnson Foundation. Go to the article at: http://www.medsch.wisc.edu/painpolicy/publicat/01annrev/contents.htm.
The Pain and Policy Studies Group (PPSG) would like to announce a recent publication about prescription monitoring programs. It may be of interest to health professionals, law enforcement, regulatory personnel and pain patients. For further information, please contact Jody Jorenby, Communications Coordinator, jpjorenby@facstaff.wisc.edu, 608-263-5438.
The March 2002 issue of the Journal of Pain and Symptom Management describes a collaborative project initiated by the Pain & Policy Studies Group that brought together regulatory and pain management representatives to exchange information and views about PMPs. The objective of this article is to provide accurate information about PMPs, address the balance between preventing drug diversion and providing pain management, and encourage continued dialog and cooperation between regulatory and pain management groups. The authors include staff members of the PPSG, representatives of state PMPs, as well as the DEA. This project was supported by the Robert Wood Johnson Foundation. Go to the article at: http://www.medsch.wisc.edu/painpolicy/publicat/02jpsm2/index.htm.
The Pain & Policy Studies Group (PPSG) of the University of Wisconsin Comprehensive Cancer Center invites you to a presentation and discussion titled, CANCER, PALLIATIVE CARE, AND MORPHINE USE IN INDIA by Dr. M.R. Rajagopal, Professor of Anesthesiology, Medical College of Calicut, India and Director, Pain and Palliative Care Society, Calicut. Dr. Rajagopal's presentation and discussion will be given on Monday, June 3 from 5:00 p.m. until 6:00 p.m. in the lower-level conference room of University Research Park’s 406 Science Drive location. Parking is plentiful and free. An informal reception will follow.
RSVPs for both the presentation and reception are appreciated by Wednesday, May 29, to Linda Gorman at 608-263-7662 or llgorman@wisc.edu.
David E. Joranson, director of the Pain & Policy Studies Group, is the recipient of the second Marie Nyswander Humanitarian Award for his “extraordinary efforts to enhance the compassionate care of addiction and pain.” The award was presented to Mr. Joranson at the International Conference on Pain & Chemical Dependency in New York City on June 7, 2002.
The late Dr. Marie Nyswander and her husband Dr. Vincent Dole have been pioneers in the treatment of opiate addiction through methadone treatment. Their distinctive mission and life work, dedicated to understanding opiate addiction and ministering compassionate care to opiate addicted persons, has helped enrich and indeed save the lives of thousands.
The Pain & Policy Studies Group (PPSG)/World Health Organization Collaborating Center, would like to inform you of additions to its web site pertaining to international opioids policy and access to opioid analgesics.
(1) The World Health Organization’s 2000 publication, “Achieving Balance in National Opioids Control Policy: Guidelines for Assessment” is available in English, French, Italian, and Spanish. The Guidelines explain why national governments are obligated to ensure adequate availability of opioid analgesics, and provides 16 guidelines and a checklist that can be used by governments and health professionals to assess “balance” in the national opioids control policies of any country. Please see http://www.medsch.wisc.edu/painpolicy/publicat/00whoabi/00whoabi.htm.
(2) PPSG monographs are now available that present key resources as well as trends in opioid consumption: global, regional (Africa, Asia, Latin America, Europe) and selected countries. The monograph for Latin America is available in English and Spanish. A fact sheet on the availability of morphine in India is available. Go to http://www.medsch.wisc.edu/painpolicy/publicat/monograp/globaltrends.htm.
(3) The World Health Organization Collaborating Center's report about activities to improve cancer pain relief in the world during 2001 is available at http://www.medsch.wisc.edu/painpolicy/publicat/01report/intro.html. The report details the continuing progress of the WHO Demonstration Project in India; it reports on the Center’s assistance to the Italian Ministry of Health in developing a proposal in 2000 to reform national policy, including simplification of opioid prescribing requirements; and it reviews activities with national governments and non-governmental organizations in several countries in Europe and Asia. We also report on the activities of the global communications program, the centerpiece of which is the publication of Cancer Pain Release, a quarterly WHO newsletter.
Dear Colleagues:
Of what value is good policy if no one knows about it? The Pain & Policy Studies Group (PPSG) wishes to announce the addition of a recent article to our web site, entitled “North Carolina, pain management and end-of-life care: Communicating the policy.” It describes the efforts of the North Carolina Medical Board (NCMB) to develop and communicate new pain-related policies to licensees and the public. The NCMB is an example of how a state medical board can be proactive in the development and communication of policies to improve pain management and end-of-life care. View the article at http://www.medsch.wisc.edu/painpolicy/publicat/02fsmb/index.htm.
SOON TO BE AVAILABLE ON-LINE:
A special issue of the Clinical Journal of Pain included a PPSG article on the
status of federal and state policies governing the medical use of opioid analgesics
for pain management with patients with an addictive disease. The article focuses
on specific policy barriers and recent policy initiatives that may improve the
use of controlled substances to treat pain for all patients, including those
with addiction. The citation can be found at http://www.medsch.wisc.edu/painpolicy/biblio.htm
under United States Publications and the text of the article will be available
on our web site in a few short weeks.
Staff members of the PPSG take this opportunity to wish you happy holidays and peace for the New Year.
With warm wishes,
David Joranson
Sophie Colleau
Aaron Gilson
Karen Ryan
Janet Kline
Martha Maurer
Jody Jorenby
Linda Gorman
The Pain & Policy Studies Group is pleased to announce that a new on-line issue of Innovations in End-of-Life Care regarding efforts to improve the availability of opioid analgesics in Latin America has just been published at http://www.edc.org/lastacts/
A Model for Improving Access to
Opioids: The Latin American Experience
January-February 2003, Vol. 5, No. 1
Read about the work of David Joranson, MSSW, and Liliana De Lima, MHA in this issue to understand how these leaders have worked with regulators, clinicians to begin to make opioid medications more available to patients in Latin America. Print friendly pdf versions are now available to download!
EDITORIAL
Opioid Availability in Latin America as a Global Problem: A New Strategy with
Regional and National Effects
by Liliana De Lima, MHA, of the International Association for Hospice and Palliative
Care
http://www2.edc.org/lastacts/editorial.asp
FEATURED INNOVATION
Improving Availability of Opioid Pain Medications: Testing the Principle of
Balance in Latin America by David E. Joranson, MSSW, of the Pain and Policy
Studies Group
http://www2.edc.org/lastacts/featureinn.asp
PERSONAL REFLECTIONS
Relieving Pain and Suffering in Colombia: One Regulator's Journey by Maria Cristina
Chirolla, JD
http://www2.edc.org/lastacts/reflections.asp
Visit many relevant links on the
Resources and Tools page at
http://www2.edc.org/lastacts/resources.asp
Find targeted references on the
Read More page at
http://www2.edc.org/lastacts/readmore.asp
We wish to announce a recent communication from the U.S Drug Enforcement Administration (DEA) relating to prescriptions for controlled substances. From time to time there are questions that physicians and pharmacists have about how federal controlled substances requirements pertain to specific situations, the answers to which may not be readily apparent in federal regulations. Recently, Dr. Howard Heit and David Joranson asked DEA for clarification about the practice of writing more than one prescription for a controlled substance at a time for a patient to cover an extended period of treatment. DEA provided its response, which can be accessed at http://www.medsch.wisc.edu/painpolicy/domestic/DEA_Rx.pdf. In addition, Dr. Heit has produced a set of PowerPoint slides about federal controlled substances regulations governing prescribing and dispensing, which may be accessed at http://www.asam.org/pain/federal_regulations_for_prescrib.htm.
The Pain and Policy Studies Group would like to draw your attention to a recent report which reaffirms the support of international narcotics regulatory officials for efforts to improve the availability of opioids for the relief of pain. The Report of the International Narcotics Control Board for 2002 states that the “Board welcomes the continued work of WHO…and supports the regional workshops on palliative care that have been organized by WHO. During 2002, such workshops were held in Africa, the Americas and Eastern Europe.” The Report noted the Congress of the Latin American Association of Palliative Care held in Guadalajara, Mexico in March 2002, which reviewed progress to improve opioid availability in Latin America. Previously, the INCB recognized WHO efforts to address regulatory impediments to opioid availability in India and Italy. The Board also endorsed the use by countries of the document “Achieving balance in national opioids control policy: guidelines for assessment.”
The WHO reports on regional palliative care and opioid availability workshops, as well as global and national opioid consumption trends, are available at: http://www.medsch.wisc.edu/painpolicy/publicat/monograp/globaltrends.htm
The 2002 INCB Report can be seen at http://www.incb.org/e/ind_ar.htm
The WHO guidelines are on-line at http://www.medsch.wisc.edu/painpolicy/publicat/00whoabi/00whoabi.htm
ITALY REFORMS NATIONAL POLICY FOR
CANCER PAIN RELIEF AND OPIOIDS
Blengini, C., Joranson, D. E. & Ryan, K. M.
An article describing recent steps taken to reform national narcotics and opioid prescribing policy in Italy was published in the March 2003 issue of the European Journal of Cancer Care. National experts have previously reported that cancer pain is inadequately treated and that opioids are underutilized. The International Narcotics Control Board expressed concern that the consumption of opioid analgesics in Italy is low compared to other developed countries in Europe, and that opioids may not be sufficiently available for the relief of pain in suffering cancer patients. The reasons include strict national requirements for prescribing, including the complex Special Prescription Form and limitation of prescriptions to an 8-day supply.
A working group appointed by Italy’s Ministry of Health (MOH), using technical assistance from the Pain & Policy Studies Group (PPSG) and the World Health Organization’s guidelines for achieving balanced opioids control policy, issued a proposal to reform national policy in 2000. The proposal was adopted by Italy’s Parliament in 2001. The new legislation included: revision of the prescription form so that it is similar to the standard form for reimbursable drugs; increase of the prescription quantity to a one month supply; ability to prescribe two drugs on a single prescription form; adding several pain medications to the list of reimbursable drugs in the national healthcare system; and allocating funds to improve physician education and public awareness of cancer pain management. If implemented by the government and health professionals, these changes can be important steps toward relieving cancer pain in Italy.
To view the article, please visit the Pain & Policy Studies Group web site at http://www.medsch.wisc.edu/painpolicy/publicat/03ejcc/index.htm
Dear Colleague,
The Pain & Policy Studies Group is preparing to release its Progress Report Card (PRC), a product of our ongoing pain and public policy research program. The PRC grades and ranks states based on an updated evaluation and quantification of state pain policies. The criteria-based evaluation will be released concurrently in an updated Evaluation Guide.
Tuesday, September 16 has been chosen as the release date for these two products, with an embargo imposed until 5:00 a.m. on that date. The purpose of this advance notice is to inform you of its pending release, enabling you and/or your organization to plan or respond to media coverage, to prepare communications with your associates, and to prepare any policy change strategies in the states.
If you would like further information, Last Acts is providing two September Partner Calls scheduled for Friday, September 5, at 11:00 am ET and Friday, September 12, at 2:00 pm ET. David Joranson and Aaron Gilson of the Pain and Policy Studies Group will discuss the soon-to-be published PRC. Learn how you can use the information contained in the state-by-state report card to promote balanced controlled substances and medical practice policy relating to pain management in your state. To register, please contact Michelle O'Connor at michelleo@stewcommltd.com or 312-751-0147. (Please note that you are not required to be a Last Acts Partner to participate in the call-ins.)
Although embargoed until September 16, the Progress Report Card, the Evaluation Guide, a cover letter and an FAQ can be downloaded from http://www.medsch.wisc.edu/painpolicy/2003_balance. To request a hard copy of the Progress Report Card and a CD with all of the materials, please contact Jody Jorenby at 608-263-5438 or jpjorenby@wisc.edu. Please let me know if we can be of any assistance to you.
The Pain & Policy Studies Group at the University of Wisconsin today released its Progress Report Card (PRC), a product of the ongoing pain and public policy research program. The PRC grades and ranks states based on a recently updated evaluation and quantification of state pain policies. The report is accompanied by a companion policy analysis, the second edition of Achieving Balance in Federal and State Pain Policy: A Guide to Evaluation (2003). The work is supported by the Robert Wood Johnson Foundation. For more information and to view both documents, the national press release, and supplemental information please go to http://www.medsch.wisc.edu/painpolicy/2003_balance/.
Dear Colleagues,
Cordial greetings from the Pain & Policy Studies Group in Madison, Wisconsin. We are happy to provide you with a link to a new section of our website that contains new educational resources about opioid consumption trends.
In June of this year, we sent you an update about activities since the February 2002 WHO workshop that a team from your country attended in Budapest, Hungary. At that time, we promised to send you opioid analgesic consumption statistics for each of the participating countries and also for the region. This information is available on the PPSG web site at http://www.medsch.wisc.edu/painpolicy/internat/E.Europe/Eastern_Europe.htm. Please have a look and let us know if it is useful information for you.
In this new Eastern Europe section of our website, you will also find the WHO Budapest Workshop report, including the country reports and action plans, as well as the detailed monograph that we presented at the workshop. You can view these materials, or download and print them. We will add more information in the next months. We hope that you can use the information in education programs for policy makers and your colleagues to emphasize the need to improve availability and patient access to pain relief.
We are very happy to receive your comments on this information, including how it can be improved. As always, please keep us informed of any progress or changes, and tell us how we may be of assistance. Karen Ryan can be contacted at kmryan2@wisc.edu.
The Pain & Policy Studies Group would like to announce the addition of a new section to our website about the work by our WHO Collaborating Center with governments and colleagues in Eastern Europe. The section contains opioid consumption statistics and trends for selected countries, as well as WHO Workshop reports, country reports, action plans, and detailed monographs. All are available for printing or downloading at http://www.medsch.wisc.edu/painpolicy/internat/E.Europe/Eastern_Europe.htm.
This section will be updated periodically, and new sections will be added for other regions of the world.
Availability of regulated pain medications in Europe and the former Soviet Union: East vs. West
The World Health Organization
continues to emphasize that opioid analgesics must be adequately available for
the relief of pain due to cancer.1-3
Patient access to pain relief is particularly important in low and middle income
countries where most cancer is not diagnosed until the late stages, when pain
is prevalent. Opioid analgesics are also needed for the relief of pain due to
HIV/AIDS.4,5 When
opioids are not available, the tremendous and growing burden of cancer and AIDS
is increased further by unrelieved pain and suffering. Improvements will occur
only if health system and regulatory barriers, including excessive restriction
of opioids, are identified and overcome.
Most governments are party to the 1961 Single Convention on Narcotic Drugs,
and thus are obligated to ensure the adequate availability of opioid analgesics
for the relief of pain and suffering. According to the International Narcotics
Control Board (INCB), many governments have yet to examine their laws and regulations
for unduly restrictive regulatory provisions.6
Examples include burdensome licensing requirements, punitive legal sanctions,
complex prescription regulations and limits on dose and prescription quantity.
Patients who need pain relief seldom receive the pain treatment that was recommended
by the WHO in 1986, almost 20 years ago.
A review of INCB statistical data reported by governments and controlled for
population reveals that, in 2001, Western European countries accounted for 88%
of all medical morphine consumed in the European region.a
The corresponding data for fentanyl, hydromorphone, oxycodone, and pethidine
are 85%, 100%, 99.6%, and 57%, respectively. In fact, consumption of opioid
analgesics in Western Europe has consistently exceeded that of the rest of the
region over the past 15 years. This persistent disparity, especially in light
of the increasing incidence of HIV/AIDS and cancer in Eastern Europe should
be addressed if European goals for palliative care are to be met.7
The University of Wisconsin Pain & Policy Studies Groupb
is developing a resource program to assist in the improvement of policies governing
the medical availability of opioid pain medication in Eastern Europe through
a grant from the Open Society Institute (see http://www.medsch.wisc.edu/painpolicy/internat/E.Europe/Eastern_Europe.htm).
For further information, contact Karen Ryan, Senior Policy Analyst, kmryan2@wisc.edu.
A valuable resource for additional information about palliative care in Europe
was published in 2002.8
a The European region is defined
as the member countries of the World Health Organization EURO region, which
includes Western, Central and Eastern Europe, and the former Soviet Union. A
complete listing of EURO member countries can be found at http://www.who.dk/countryinformation
b The Pain & Policy Studies Group is designated
a World Health Organization Collaborating Center for Policy and Communications
in Cancer Care.
Reference List
(1) World Health Organization.
National Cancer Control Programmes: Policies and Managerial Guidelines. Second
ed. Geneva, Switzerland: World Health Organization; 2002. (Available at http://www.who.int/cancer/nccp/nccp/en/).
(2) World Health Organization Cancer and Palliative Care Unit. Consultation
on Strategies to Improve and Strengthen Cancer Control Programmes. World Health
Organization; Geneva, Switzerland. Meeting held in Geneva, Switzerland; 25 -
28
November 2003. (Available at http://www.who.int/cancer/nccp/europeanconsultation/en/index.html).
(3) World Health Organization. Achieving Balance in National Opioids Control
Policy: Guidelines for Assessment. Geneva, Switzerland: World Health Organization;
2000. (Available at http://www.medsch.wisc.edu/painpolicy/publicat/00whoabi/00whoabi.htm).
(4) World Health Organization. Progress Report: Community Health Approach to
Palliative Care for HIV/AIDS and Cancer Patients in Africa. Geneva, Switzerland:
2002.
(5) World Health Organization HIV-AIDS. Palliative Care. Geneva, Switzerland:
World Health Organization; 2004. (Available at http://www.who.int/hiv/topics/palliative/care/en/).
(6) International Narcotics Control Board. Report of the International
Narcotics Control Board for 1995: Availability of Opiates for Medical Needs.
New York, NY: United Nations; 1996. (Available at http://www.incb.org/e/ind_ar.htm).
(7) Council of Europe. Recommendation (2003) 24 of the Committee
of Ministers to Member States on the Organisation of Palliative Care. Adopted
by the Committee of Ministers at the 860th meeting of the Ministers' Deputies;
12 November 2003.
(Available at http://www.coe.int/DefaultEN.asp).
(8) Clark D, Wright M. Transitions in End of Life Care: Hospice
and Related Developments in Eastern Europe and Central Asia. Buckingham, UK:
Open University Press; 2002. (Website for the International Observatory on End
of Life
Care is http://www.eolc-observatory.net/).
Dear Colleague,
1) WHO Cancer Control
Initiative, including palliative care and opioid availability: This is to inform
you that on 24 May 2004 the World Health Organization Executive Board will consider
a draft resolution on cancer prevention and control. In an unprecedented move,
the WHO calls for action to be taken in the face of the increasing burden of
disease caused by cancer and the availability of effective interventions adaptable
to different resource settings. WHO has made the document available for download
at http://www.who.int/gb/EB_WHA/PDF/EB114/B114_3-en.pdf.
(Our recent attempts to download this document have been unsuccessful; if you
need a fax or scan copy, please contact Ms. Jody Garthwaite (jgarthwaite@wisc.edu)
at the Pain & Policy Studies Group. The list of Member States and their
delegates to the Executive Board is available at http://www.who.int/governance/eb/eb_members/en/.
2) International Narcotics Control Board Opioid Availability Initiative: In
addition, we understand that the International Narcotics Control Board will
make a presentation to the WHO Executive Board about its concerns regarding
the continuing inadequate availability of opioids for medical purposes in many
low and middle income countries, including for pain and palliative care.
Cooperation between the international narcotics regulatory agency and the World
Health Organization
cancer control program is a most welcome development and will be followed closely.
Sincere regards,
David E. Joranson
Senior Scientist, Director
Pain & Policy Studies Group
World Health Organization Collaborating Center for Policy and Communications
University of Wisconsin Comprehensive Cancer Center
406 Science Drive, Suite 202
Madison, Wisconsin 53711-1068
tel 1 608 263 7662
fax 1 608 263 0259
email: joranson@wisc.edu
websites
http://www.medsch.wisc.edu/painpolicy
http://www.WHOcancerpain.wisc.edu
Guidelines for patients traveling with controlled substances
Periodically the Pain & Policy Studies Group is asked what should a patient know about traveling abroad with prescribed opioid analgesics? PPSG has placed on its website the answers provided by governments. See http://www.medsch.wisc.edu/painpolicy/internat/travel.htm
Patients need to consider two sets of law: 1) the law of the country they are in and 2) the law of the country or countries to which they are traveling. Links to two documents that explain the governmental requirements are provided: the U.S. Code of Federal Regulations and Guidelines from the International Narcotics Control Board.
Please consider forwarding this information to physicians, nurses, social workers and others who are involved in assisting patients to plan for travel.
New Guidelines for Assessment & Management of Chronic Pain
PPSG would like to call your attention to new Guidelines for the Assessment and Management of Chronic Pain. They were produced by a panel of experts for the Wisconsin Medical Society, chaired by Sridhar Vasudevan, MD, and published recently in the Wisconsin Medical Journal, Volume 103, No. 3, 2004. They are clear, balanced and contain recommended reading, a pre-visit health questionnaire, equianalgesic dosing table, a patient-physician agreement and guidelines for the use of controlled substances, and a summary of relevant Wisconsin controlled substances laws and regulations.
According to Dr. Vasudevan, "The new Guidelines are designed to support Wisconsin's primary care physicians as well as non-physicians to provide quality management of patients with persistent pain. The Task Force recognized and addressed the fact that many physicians find pain difficult to diagnose and treat and may be reluctant to use the full spectrum of available analgesics due to concern about regulatory oversight or undue fears that patients will develop addiction. The new guidelines emphasize an open approach to the patient, consideration of multiple etiologies, consultation, development of a treatment plan, careful documentation, communication among treating professionals, patient responsibilities and self-management skills."
The guidelines can be accessed at http://www.wisconsinmedicalsociety.org/uploads/wmj/pain_manageguides.pdf, or by calling the Wisconsin Medical Society WMS at 800-362-9080.
A balanced approach to prescription pain medications
On August 11, 2004 the U.S. Drug Enforcement Administration released an FAQ in cooperation with pain and addiction experts, the Last Acts Partnership and the University of Wisconsin Pain & Policy Studies Group. The FAQ stresses the need for education of clinicians, law enforcement and regulators about "balance", so that efforts to treat pain avoid contributing to abuse and efforts to stop diversion do not interfere with pain management.
How should the messages in the FAQ be communicated and implemented? How could you or your organization help to ensure that the FAQ reaches clinical and enforcement/regulatory audiences in your country or state, as well as the public? Is there a need in your area for better balance? Do clinicians fear investigation? Do clinicians know how to manage pain and also how to minimize abuse? Can patients obtain their medications when they are medically necessary? Are the specific sources of diversion of pain medication understood and being addressed without interrupting legitimate medical practice and patient care? How could a balanced approach be further incorporated into clinical practice, law enforcement and regulation? Are there opportunities to encourage a more balanced medical and regulatory environment for pain management, through websites, newsletters, articles, conferences, policy development, work with the media? How could "balance" be explored with national and state medical, pharmacy and nursing organizations, and with regulatory and enforcement agencies? Is this an appropriate topic for discussion by the boards of directors, steering committees and advisory panels of pain, palliative care, and end-of-life organizations?
You may contact the DEA to obtain hard copies of the FAQ by calling (202) 307-7297. (HARD COPIES WILL NOT BE AVAILABLE UNTIL OCTOBER.) The FAQ is available on the PPSG website at www.medsch.wisc.edu/painpolicy; you are welcome to link to it. Please contact Jody Garthwaite at jgarthwaite@wisc.edu for assistance. On the PPSG website you will also find resources that further explain the balanced approach to pain, addiction and diversion, including studies about knowledge and attitudes of pharmacists and medical regulators, evaluations of federal and state policies, and a full text database of state pain policies.
In the next two weeks, PPSG will send you an email about a new article that updates trends in the medical use and abuse of opioid pain medications and discusses the sources of diversion and the need for balance in addressing abuse and diversion of pain medications.
In our August 18 announcement regarding the DEA/Last Acts Partnership/PPSG release of the FAQ (http://www.medsch.wisc.edu/painpolicy/domestic/DEA_faq.htm), we mentioned that the Pain & Policy Studies Group would inform you of the publication of a new article. PPSG has used recent data to update trends in the medical use and abuse of opioid analgesics, in which there is also a discussion of the implications for controlling diversion of pain medications. The article appears in the August 2004 issue of the Journal of Pain and Symptom Management, available at http://www.medsch.wisc.edu/painpolicy/publicat/04jpsm/index.htm. This article updates earlier research published in JAMA in 2000, and uses federal data on retail distribution of controlled substances and emergency department mentions of drug abuse from 1997 through 2002.
The study examines trends in the medical use and abuse of fentanyl, hydromorphone, meperidine, morphine, and oxycodone, and compares abuse of opioids to other drug classes. Marked increases were noted in both the medical use and abuse of these pain medications; opioids accounted for 9.85% of all drug abuse in 2002, up from 5.75% in 1997. Although increased medical use of opioids is considered a general indicator of progress in providing pain relief, growing opioid abuse and diversion is an important public health concern and should be addressed in a balanced manner, without interfering in legitimate medical practice or patient care. The authors provide a discussion about the principle of balance, and a rationale for understanding, tracking, and addressing sources of abuse and diversion.
The article was reviewed by numerous experts in pain and addiction medicine, and law. Funding was provided by grants from the Robert Wood Johnson Foundation and The Project on Death in America.
On Monday, October 11, the World Health Organization will sponsor a Global Day Against Pain, organized by the International Association for the Study of Pain (IASP) and the European Federation of the IASP Chapters. This global day campaign urges that pain relief be viewed as a human right, and asks people to recognize pain as a pressing problem and to act now to relieve suffering. The conference will include presentations and discussions by numerous experts in the pain field and can be viewed by live web broadcast.
To find out more information, you can visit the IASP's website at http://www.iasp-pain.org/Global%20Day.html or through the home page of the Pain & Policy Studies Group website.
On August 11, 2004, the U.S. Drug Enforcement Administration (DEA), the Last Acts Partnership, and the University of Wisconsin Pain & Policy Studies Group (PPSG) released "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals, and Law Enforcement Personnel." The DEA has recently removed this document from their website and consequently has asked the PPSG to remove it from our site as well. Check the DEA's website for a statement explaining the removal of this document. We deeply regret any inconvenience this may cause.
Any questions should be directed to the DEA.
On October 6, the University of Wisconsin Pain & Policy Studies Group (PPSG) announced a communication we received from the Drug Enforcement Administration (DEA), in which we were informed by letter, dated October 4, 2004, that the DEA had rescinded it’s endorsement of the recently publicized document, Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel (FAQ). The DEA notified us that they had removed the FAQ from their website, citing that the document contained misstatements, and asked the PPSG to do likewise. The PPSG, along with several other organizations housing the FAQ, removed the document from their websites.
In response to this issue, members of the principal working group involved in the FAQ (Steven Passik, PhD; Russell Portenoy, MD; and David Joranson, MSSW) have written a letter to the DEA Administrator Karen Tandy. The letter asks that the DEA: (1) publicly reaffirm its commitment to achieving balance, (2) explain the misstatements in the FAQ so they can be addressed, (3) advise as to whether the agency plans to revive and disseminate the FAQ or a similar educational effort, and (4) tell how the agency proposes to restart a dialogue with the clinical community that is dedicated to pain management.
A copy of both letters can be seen on the PPSG website at the following URL: http://www.medsch.wisc.edu/painpolicy/DEA/index.htm
Missouri, Minnesota, and Virginia Adopt New Pain Policies
Following the adoption of the Federation of State Medical Board’s “Model Policy for the Use of Controlled Substances for the Treatment of Pain,” (“Model Policy”) in May, 2004, state health professional regulatory boards in Missouri, Minnesota and Virginia adopted new pain policies.
The Missouri State Board of Healing Arts recently adopted a modified version of the Model Policy. To read the full text of the policy: http://pr.mo.gov/boards/healingarts/CSGUIDE.pdf
The Virginia Board of Medicine adopted the Model Policy in its entirety in June of 2004. To read the full text of the policy: http://www.medsch.wisc.edu/painpolicy/domestic/vamodpol.htm
In addition, the Minnesota boards of Medical Practice, Nursing and Pharmacy issued a “Joint Statement on Pain Management” in September of 2004. To read the full text of the policy: http://www.state.mn.us/cgi-bin/portal/mn/jsp/content.do?subchannel=null&programid=536904249&sc3=null&sc2=null&id=-536886235&agency=BMP
As a reminder, the Pain & Policy Studies Group at the University of Wisconsin provides public access to the full text of all state pain policies at http://www.medsch.wisc.edu/painpolicy/matrix.htm. Comments and questions are always welcome.
The Drug Enforcement Administration (DEA) has issued an Interim Policy Statement (IPS) in the Federal Register (Vol. 69, No. 220) regarding the document "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel." The IPS describes the "misstatements" identified in the document by the DEA and explains how the DEA plans to address them and the issue of dispensing controlled substances for the treatment of pain in a future Federal Register.
The IPS can be found
at:
http://a257.g.akamaitech.net/7/257/2422/06jun20041800/edocket.access.gpo.gov/2004/pdf/04-25469.pdf
The PPSG is evaluating the IPS and preparing a response.
In response to the DEA’s Interim Policy Statement (IPS) issued in the November 16, 2004 Federal Register, the University of Wisconsin Pain & Policy Studies Group has submitted a written response. A PDF version of the letter, as well as the sequence of events prior to this response, is available at http://www.medsch.wisc.edu/painpolicy/DEA/index.htm.
The University of Wisconsin Pain & Policy Studies Group (PPSG) recently hosted a 5-person delegation from Romania to examine and recommend changes in the Romanian regulatory system. The purpose of this project is to make opioid analgesics more accessible to patients for pain relief and palliative care. The delegation included regulatory experts from the Ministry of Health, as well as representatives of oncology, palliative care, pharmacology and pharmacy.
In 2003, PPSG worked with a Palliative Care Commission in Romania to recommend changes to the national narcotics control law. This law dates from the Communist era, and severely limits the use of opioid analgesics in today’s hospice and palliative care programs. During this recent visit, PPSG worked with the delegation to draft a regulation that will implement the new law and the simplified prescription system.
Click here to see an article (PDF) that explains more about the situation in Romania and the objectives of this project.
For further information about our work in Romania and Eastern Europe, please visit: http://www.medsch.wisc.edu/painpolicy/internat/E.Europe/Eastern_Europe.htm
In response to the DEA's Solicitation of Comments dated January 18, 2005 (Docket No. DEA-261), the University of Wisconsin Pain & Policy Studies Group has submitted a written response. Individuals and organizations are welcome to refer to it. A PDF version of the letter is at http://www.medsch.wisc.edu/painpolicy/DEA/DEA_261_response.pdf.
Please note that to be eligible for official consideration, all comments, including those which may have been sent earlier, must reference the Docket Number, and be sent to DEA according to the instructions in the January 18 solicitation, which is at http://www.medsch.wisc.edu/painpolicy/DEA/FR_pain_solicit.pdf.
Dear Colleagues
The Pain & Policy Studies Group would like to call your attention to materials it prepared for the 2nd Global Summit for Hospice and Palliative Care Associations and the 6th Asia Pacific Hospice Conference held recently in Seoul, Korea. The following materials can be found at http://www.medsch.wisc.edu/painpolicy/internat/conferences.htm:
1) Selected Resources about Opioid
Availability (monograph),
2) Resources for Addressing Barriers to Pain Relief in the World, and
3) individual graphs of morphine consumption for the participating countries,
including
Update on state prescription monitoring programs. According to a recent review
by the Pain & Policy Studies Group (PPSG), 21 states have PMPs or legislation
that allows implementation of a PMP. There has been a steady increase in the
number of states with PMPs that rely on electronic transmission of prescription
data and that monitor most or all classes of controlled substances. In addition,
several more states are considering PMP legislation. The PPSG encourages publication
of studies that show that PMPs reduce drug abuse and diversion without interfering
in medical practice.
A trend graph and listing of states
can be found at:
http://www.medsch.wisc.edu/painpolicy/domestic/diversion.htm
The
2000 WHO Guidelines are now also available in Turkish and Mongolian 10/18/05 |
Dear International Colleagues,
This is to inform you that the 2000 World Health Organization guidelines, “Achieving Balance in National Opioids Control Policy” are now available via our public access website in Bulgarian, German, Lithuanian, Polish, and Ukrainian as well as English, French, Italian, Romanian, Russian, and Spanish. As you may know, WHO designed these guidelines for governments and healthcare professionals to assess national opioids control policies and their administration to determine if they contain the provisions, administrative procedures and cooperation that are necessary to ensure availability of opioid analgesics for pain relief and palliative care. These guidelines are an essential tool in our ongoing work in Eastern Europe to improve patient access to pain medications.
The WHO guidelines, now available in all 11 languages, can be found at http://www.medsch.wisc.edu/painpolicy/publicat/00whoabi/00whoabi.htm
We are grateful to the Open Society Institute for its ongoing support of work in Eastern and Central Europe and the Former Soviet Union countries. For more information, please contact Karen Ryan at kmryan2@wisc.edu.
The Pain & Policy Studies Group
is pleased to announce publication of “Improving
Cancer Pain Relief in the World: Report for 2004.” The report describes
the work accomplished by the World Health Organization Collaborating Center
for Policy and Communications in Cancer Care (the Center), which is sponsored
by the Pain & Policy Studies Group at the University of Wisconsin Comprehensive
Cancer Center.
Highlights of the report include:
Policy research and development projects in India with state governments and
palliative care professionals to improve access to opioid analgesics for treating
cancer pain.
Reform of narcotic control policies in Romania, which included visits to the
country to study the Romanian health and regulatory system for making opioid
analgesics available for pain relief, and a study visit to the Center by a team
from the Romanian Ministry of Health to draft new national opioid regulations.
A monograph is available at http://www.medsch.wisc.edu/painpolicy/publicat/monograp/romania04.pdf.
Assistance to the Middle East Cancer Consortium (MECC) sponsored by the United
States National Cancer Institute. A presentation about improving access to opioid
analgesics for pain relief in the Middle East was given at a workshop in Cyprus
for the countries of Cyprus, Egypt, Israel, Jordan, and Turkey. A monograph
of opioid consumption trends for the Middle East, highlighting the participating
countries, can be accessed at http://www.medsch.wisc.edu/painpolicy/publicat/monograp/cyprus04.pdf.
A Spanish-language monograph was prepared for the 2nd Latin American Congress
of Palliative Care in Montevideo, Uruguay and is available at http://www.medsch.wisc.edu/painpolicy/publicat/monograp/uruguay04.pdf.
The brief monograph contains a table of the 2001 milligrams per capita consumption
of certain opioids for all of the countries participating in the Congress.
A pdf version of the full report can be seen at http://www.medsch.wisc.edu/painpolicy/publicat/04report/04report.pdf.
Comments, suggestions and questions are welcome.
The Pain and Policy Studies Group (PPSG) would like to call your attention to a recent article titled “Progress to Achieve Balanced State Policies Relevant to Pain Management and Palliative Care, 2000-2003”, published in the Journal of Pain & Palliative Care Pharmacotherapy. This article summarizes and discusses the evaluation and grading of state pain policies and reports on positive policy changes at the state level. A PDF version of the article can be accessed on the PPSG website: http://www.medsch.wisc.edu/painpolicy/publicat/05jppcp/05jppcp.pdf
The Pain and Policy Studies Group (PPSG) would like to call your attention to a recent article titled "State policy affecting pain management: Recent improvements and the positive impact of regulatory health policies," published in the journal Health Policy.
This article describes statistical analyses of a criteria-based evaluation of state drug control and professional practice policies that impact using controlled substances for pain management. The study compared content of: (1) policies active in 2000 with those in 2003, (2) statutes, regulations, and board guidelines and policy statements, (3) pain management policies to professional practice policies, and (4) pain management policies adopted by health care regulatory boards to those by state legislatures. Results showed that current policies contained more language that encouraged appropriate pain relief while also avoiding language restricting professional decision-making and patient treatment. Regulatory board guidelines and policy statements were more likely than statutes and regulations to promote pain management and have no restrictive language, and were less restrictive than policies that govern general professional practice. Recent policy improvement seems to result largely from regulatory board activity. The authors discuss the need to continue striving to attain balanced policy as a way to address the current public health problem of under-treated pain.
A PDF version of the article can be accessed on the PPSG website: http://www.medsch.wisc.edu/painpolicy/publicat/05hlthpol/05hlthpol.pdf
In July 2005, the PPSG conducted a search for state policies that either require or encourage physicians to take continuing medical education (CME) in pain management or palliative care. Ten states have such policies; five require CME in pain management or palliative care, while 5 encourage such CME. A few states also require or encourage medical school curriculum that includes pain management or palliative care. This review focused on policies related to physicians. Please let us know if you are aware of similar policies in your state or other states. The verbatim policy language and references for these policies can be found on the PPSG website at: http://www.medsch.wisc.edu/painpolicy/domestic/cme.htm
CONTACT: David E. Joranson 608-263-7662
or Linda Dietrich 608-263-6585
Pharmacy theft is an overlooked source
of abused pain medications
MADISON – A research letter published by the Journal of Pain and Symptom
Management reports that every year, thousands of armed robberies and thefts
from pharmacies, manufacturers and distributors result in millions of dosages
of opioid pain medications being diverted into the illicit market. The medications
are trafficked by drug dealers and then abused, often in combination with alcohol
and other drugs, leading to overdose and death.
“Drug Crime is a Source of Abused Pain Medications in the United States”
was written by David E. Joranson, MSSW, and Aaron M. Gilson, PhD, of the Pain
& Policy Studies Group at the University of Wisconsin Comprehensive Cancer
Center. The letter describes data received from the US Drug Enforcement Administration
(DEA) under a Freedom of Information Act request. The request was for theft
reports of prescription controlled substances that had been submitted to the
DEA by DEA registrants on federal Form 106. The information provided contained
analyzable data for only 22 Eastern states representing approximately one-half
the US population.
In the four-year period from 2000 to 2003, nearly 28 million dosage units of
all prescription controlled substances were diverted in 12,894 separate incidents
primarily involving pharmacies, and averaging more than 3,000 incidents per
year. In 2003, approximately 5.8 million dosages of opioid pain medications
were diverted, including hydrocodone, oxycodone, morphine, methadone, meperidine,
hydromorphone and fentanyl.
Diversion of this type occurs at places in the drug supply chain above the level
of prescribing, dispensing and patient use, and involves individual and organized
criminal activity by persons who are not licensed or registered to handle controlled
substances, and therefore would not be detected by programs that monitor prescribing.
The taking of controlled substances by force from DEA registrants became a federal
felony in 1984; more information is needed about how law enforcement is addressing
drug crimes against DEA registrants as a part of the national coordinated response
to prescription drug diversion. Addressing pharmacy theft could become a model
for achieving hoped-for “balanced” responses to diversion, because
these sources of diversion can be identified and addressed with little if any
risk of interfering in legitimate medical practice and patient care.
Future studies should examine trends and whether pharmacy thefts occur in particular
states and metropolitan or rural areas, evaluate the causes and methods of preventing
pharmacy crime, and determine what proportion of total diversion and abuse comes
from pharmacy theft or from other sources such as fraudulent prescriptions or
“pill mills.” Existing national drug abuse databases should collect
information on the source of abused drugs to a more evidence-based face on how
abused prescription pain relievers are obtained.
Joranson DE, Gilson AM. Drug crime is a source of abused pain
medications in the United States. J Pain Symptom Manage. 2005; 30(4):299-301.
(Available at http://www.medsch.wisc.edu/painpolicy/publicat/05jpsm/05jpsm.pdf.)
Dear Colleague,
As 2005 comes to a close, I would like to extend my best personal wishes to you for a healthy and successful New Year--and offer a few reflections on the year past and ahead.
In the US, 2005 was characterized by a mix of policy setbacks, new information about the source of abused pain medications, and an important transition. Following the US Drug Enforcement Administration’s (DEA) abrupt withdrawal from the interdisciplinary and balanced pain and regulatory education initiative known as the “FAQ”, DEA reversed its own long-standing policy on issuing Schedule II prescriptions and communicated a new aggressive tone about investigations. These actions precipitated a nationwide retrenchment in care of pain patients and law-abiding physicians’ concerns about being investigated have escalated. DEA requested comments on its actions; hundreds of comments were filed from healthcare professionals, associations, regulators and law enforcement officials all over the country; DEA’s response is due early in 2006. We hope that DEA’s statement will include a recommitment to a balanced approach to diversion control that specifically avoids interfering in medical practice and patient access to pain management, assurance to practitioners that DEA agents will use diversion indicators that cannot be confused with legitimate medical practice, clarification of the increasingly blurred lines between professional practice, unprofessional conduct and criminal conduct, reaffirmation that a series of original prescriptions for Schedule II medications is legal, endorsement of the Federation of State Medical Board Model Policy, and establishment of communication mechanisms that will allow, as years past, communication between DEA and practitioner, law enforcement, regulatory and patient groups. http://www.medsch.wisc.edu/painpolicy/DEA/index.htm
In 2005, the PPSG published preliminary
first-of-a-kind quantitative data about the amount of diversion of prescription
drugs including opioid analgesics. We obtained data from federally-required
reports which showed that in the last four years approximately 28 million dosages
of prescription controlled substances were unlawfully diverted from the US drug
supply chain into channels of illicit distribution and abuse. This tremendous
quantity was based on reports from only 22 states; in 2003 alone, 5.8 million
dosages of prescription opioid analgesics were diverted in this manner. Clearly,
the reported increase in abuse of “prescription opioids” does not
necessarily mean the opioids came from prescriptions. Twenty years ago, pharmacists
terrorized by armed robberies convinced Congress to make theft of controlled
substances from DEA-registered pharmacies a federal felony. Yet today, we know
that thousands of incidents of theft and robbery resulting in diversion continue
to occur every year, and we know nothing about the law enforcement response.
A fair and balanced federal approach to prescription drug abuse must take into
consideration all sources of diversion, including those criminal activities
for which DEA-registered pharmacists and physicians are not responsible.
http://www.medsch.wisc.edu/painpolicy/publicat/05jpsm/05jpsm.pdf
2005 was also a year for important transitions. Patricia Good retired from the DEA. She understood pain management and was a clear voice within DEA for balanced law enforcement approaches to drug diversion and cooperation with the pain and palliative care fields. She will be missed.
In contrast with the confusion in Washington, the States continued to make steady progress to achieve more balanced policies governing the medical use of controlled substances for pain. We have previously reported that a number of states have adopted, amended or repealed policies sufficient to improve their grade for balanced pain policy. http://www.medsch.wisc.edu/painpolicy/publicat/05hlthpol/05hlthpol.pdf In 2005, PPSG policy evaluation tools continue to be used by a number of organizations as road maps for achieving more balanced state pain policies.
On the international side, 2005 has been a year of important progress. The United Nations adopted new resolutions to address inadequate relief of pain in cancer and HIV/AIDS; all national governments have been asked to examine their laws and regulations for barriers to opioid availability; the World Health Organization and the International Narcotics Control Board have been requested to explore development of an assistance mechanism to support the work necessary to improve patient access to essential medicines, in particular the opioid analgesics. http://www.un.org/docs/ecosoc/documents.asp?id=863
A collaborative project with the Ministry of Health Palliative Care Commission in Romania is coming to fruition. The project began in 2002 with a WHO workshop to assist Eastern European countries to identify and remove regulatory barriers to patient access to opioid pain medications. In November 2005, the Romanian Parliament adopted a new and modern drug control law replacing the laws of the Ceausescu regime which for decades restricted physicians from prescribing more than a 3-day supply of opioids; 10-15 day supplies were possible for cancer patients but only if they were “incurable,” and not at all for patients with HIV/AIDS. Within six months the Ministry will adopt new regulations to implement the new law; the regulations have already been drafted by a team of Romanian experts during a visit to the PPSG. We are excited that 2006 may bring a new national drug policy that will strike a balance between control and availability, allow modern pain control practices in Romania and be an example for Eastern Europe and the Former Soviet Union. Look for a journal article soon.
2006 will mark the tenth anniversary for the PPSG. We look forward to announcing plans to expand our policy research and communications programs in the US and internationally, including improvements to the PPSG website at www.medsch.wisc.edu/painpolicy. We will continue to email you periodic updates and, as always, would look forward to comments you may have as we work toward our collective vision of relieving pain and suffering.
Best wishes for the New Year
David E. Joranson, Senior Scientist
Director
Pain and Policy Studies Group
University of Wisconsin Comprehensive Cancer Center
WHO Collaborating Center for Policy and Communications in Cancer Care
Dear International Colleagues,
This is to inform you that the 2000 World Health Organization guidelines, “Achieving Balance in National Opioids Control Policy” are now available via our public access website in Mongolian, Serbian, and Turkish as well as Bulgarian, English, French, German, Italian, Lithuanian, Polish, Romanian, Russian, Spanish, and Ukrainian. As you may know, WHO designed these guidelines for governments and healthcare professionals to assess national opioids control policies and their administration to determine if they contain the provisions, administrative procedures and cooperation that are necessary to ensure availability of opioid analgesics for pain relief and palliative care. These guidelines are an essential tool in our ongoing work in Eastern Europe to improve patient access to pain medications.
The WHO guidelines, now available in all 14 languages, can be found at http://www.medsch.wisc.edu/painpolicy/publicat/00whoabi/00whoabi.htm
We are grateful to the Open Society Institute for its ongoing support of work in Eastern and Central Europe and the Former Soviet Union countries and to Dr. Odontuya Davaasuren for providing the Mongolian translation. For more information, please contact Karen Ryan at kmryan2@wisc.edu.
The Pain & Policy Studies Group (PPSG) would like to inform you of a recent Spanish-language report which provides information about the availability of opioid analgesics in the world and for countries in the region of Latin America. Titled "Descripción De La Disponibilidad De Opioides in América Latina," it was prepared for presentation at the 3rd Congress of the Latin American Association of Palliative Care in Isla Margarita, Venezuela. The report can be accessed on the PPSG website at http://www.medsch.wisc.edu/painpolicy/publicat/monograp/venezuela06.pdf.
Dear Colleagues,
There are now 21 translations of the 2000 World Health Organization guidelines document, “Achieving Balance in National Opioids Control Policy,” available on the Pain & Policy Studies Group’s public access website. Seven new translations have been added, including:
All 21 translations can be found at http://www.medsch.wisc.edu/painpolicy/publicat/00whoabi/00whoabi.htm.
Our sincere thanks to Willem Scholten, PharmD, MPA, Technical Officer of the World Health Organization’s Department of Medicines Policy and Standards for his support and assistance in obtaining these translations.
NEW PAIN POLICY FELLOWSHIP ANNOUNCED
The International Palliative Care Initiative
of the Open Society Institute
and the Pain & Policy Studies Group of the
University of Wisconsin Comprehensive Cancer Center
is pleased to announce the International Pain Policy Fellowship
Program. The overall goal of the fellowship program is to
improve the availability of opioid analgesics for pain management in developing
countries for patients with pain from cancer, HIV/AIDS, or other chronic diseases.
The two-year fellowship program will include training, mentoring, and an in-country pain policy project. A salary stipend covering up to 20% of each fellow’s professional salary will be given. Applications will be accepted from mid-career physicians, health care administrators, policymakers, or lawyers from a health care facility, policy center, or university from low- or middle-income economies (as classified by the World Bank's GNI per capita method--see World Bank GNI Data Country Classification on the web). Applicants must have a sincere interest in improving access to opioid analgesics for pain management through drug policy advocacy.
Fellows are required to participate in a five-day learner-centered training program at the University of Wisconsin in Madison, Wisconsin from 23 October to 27 October, 2006. The training program will cover the relationships between disease, pain, palliative care, and inadequate opioid availability, and will use WHO Guidelines to examine regulatory barriers and resources for evaluating national policy, as well as examples of their use. Each fellow will be responsible for outlining their drug availability project plan and timeline during the training program in Madison, and then incorporating it into their in-country pain policy project.
For more information and the application form, please visit http://www.soros.org/initiatives/health/focus/ipci/grants/palliative/guidelines.
Click here for printer-friendly (PDF) version of this announcement
Cancer foundations support evaluation of US pain policies
The Pain & Policy Studies Group (PPSG) is pleased
to announce joint funding of its US pain policy evaluation program by the American
Cancer Society, the Susan G. Komen Breast
Cancer Foundation and the Lance Armstrong
Foundation. Each of these highly respected organizations have announced
that they will provide a three-year grant to enable the PPSG to evaluate federal
and state laws, regulations and agency guidelines that can impact patient access
to effective pain relief. PPSG will prepare state policy profiles for the next
three years, as well as report cards that grade states’ policies and compare
them to the 2000 and 2003 grades. Release of the 2006 reports is anticipated
in September, which is Pain Awareness Month.
The June 24, 2006 issue of the Lancet includes an article co-authored by Dr. Daniela Mosoiu, director of Hospice Casa Sperantei in Romania, and members of the Pain & Policy Studies Group (PPSG). The article details a 3-year collaborative project to identify and remove regulatory barriers to pain relief by using the WHO guidelines to evaluate the Romanian anti-narcotics law that had been adopted in 1969 during the Ceausescu regime. A commission of Romanian pain and palliative care experts recommended changes to the law and prescribing regulations, with assistance from the PPSG. As a result, the Romanian Parliament has adopted a new law, and the Ministry of Health is currently finalizing new, simplified, regulations with approval expected later this year.
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