European Region

Regional Meeting: European Association for Palliative Care (EAPC):

The Center is an active member of the EAPC, an important non-governmental organization dedicated to promoting cancer pain relief and palliative care in Europe. The Center participated in palliative care conferences of the EAPC in Cyprus (1997), London (1997), Madrid (1998) and Geneva (1999). The Center provided several presentations as well as monographs concerning barriers to cancer pain relief and methods to improve opioid availability. In Cyprus, the Center hosted a luncheon meeting of EAPC representatives to discuss ways of improving policy relating to availability of opioid analgesics in Europe, including through European Commission reform of narcotic control policy. The Center presented on "Opioid availability: diagnosis and treatment of regulatory barriers" ²⁵ and provided technical assistance about methods to improve availability of opioids and has provided follow-up consultation to health professionals who are working on the problem. In London, the Center presented on "Reflections on addiction to morphine" ²⁶ and met with representatives of the EAPC to explore needs and opportunities for evaluating and improving national opioid policies. In Geneva, the Center provided professional education materials in English, Spanish and French, including information about all WHO publications relevant to cancer pain, opioid availability, symptom control and palliative care.

Eastern Europe:

The Center participated in the Open Society Institute's (OSI) conference "Palliative Care in Eastern Europe" in September 1999. The two-day conference was held in Geneva, Switzerland, and was attended by 50 health care professionals representing 24 Eastern European countries. The Center presented a lecture titled "Drug availability and regulations" about morphine consumption in Eastern Europe, how opioid distribution systems work, and how to overcome regulatory barriers. A follow-up session occurred on the second day of the conference, during which the Center responded to questions about opioid availability and the use of opioids. All participants received several publications from the Center.^27-30

The Center anticipates further involvement in Eastern Europe in conjunction with OSI. There has been preliminary discussion of a regional meeting on opioid availability in 2000.

Bulgaria:

At the invitation of Dr. Jan Stjernsward, the Center participated in a national strategy session to address cancer pain relief, palliative care and opioid availability in Sofia, Bulgaria in November of 1997. The Center met with representatives of the government of Bulgaria to explore the opioid availability situation and to discuss a possible action plan. The government was eager to move forward with an action plan, but resources were not available for such a plan and the Center lacked resources to support follow up activities. The Center has maintained contact with several dedicated physicians in Bulgaria in an effort to encourage their work to improve opioid availability.

Germany:

The Center takes note of the successful efforts of German colleagues, in particular those of Professor Michael Zenz of Bochum, Germany, to reform restrictive German prescription requirements for opioids. The Center was invited to participate in a special seminar on morphine and pain sponsored by Professor Zenz in 1997 in Einbeck to commemorate the isolation of morphine in 1805 by the German pharmacist, Serturner. The Center's presentation was titled "To what extent has the WHO analgesic ladder influenced morphine consumption?" ³¹ This was also an excellent opportunity to consult with Professor Zenz, and also with current and past representatives of the WHO cancer and palliative care program, its Collaborating Centers and other experts. In 1998, Professor Zenz co-authored a guide to the morphine prescribing requirements in European countries, Morphinverschreibung in Europa,³² in which appeared the monograph prepared by the Center for the meeting in Einbeck. In addition, the Center (Dr. Colleau) serves on the Editorial Board of the only German peer-reviewed journal dealing with pain control, Der Schmerz.

France:

The Center has a 10-year history of collaboration on pain research and opioid policy with French clinicians, government officials and legislators resulting in several publications. In 1997, the first multicenter study of pain prevalence and severity in AIDS patients in France, conducted in collaboration with the Center was published in the British Medical Journal.³³ In April 1998, the Center was invited to give the keynote address at the Congress of the French Society of Palliative Care. Dr. Colleau lectured in French on "The WHO Cancer Control Program: the place of pain and palliative care."

Italy:

Discussions with colleagues from EAPC based in Milan led to their interest in obtaining a better understanding of the apparent inconsistencies in the Italian morphine consumption statistics reported to the INCB, and also in changing the particularly complex prescription requirements for opioids in the class of morphine. As a result of several meetings, including with Professor Vittorio Ventafridda, the Director of the WHO Collaborating Center in Milan, in 1998 the Center began a collaborative relationship with Dr. Claudio Blengini, a general practitioner who is a member of the Special Committees of the Italian Ministry of Health on Pain and Palliative Care. The Center has provided Dr. Blengini with information and consultation to strengthen his ability to provide expert guidance to a national commission that is studying how to reform the laws of Italy with respect to the prescribing of opioids. Dr. Blengini published an article, making use of information obtained from the Center.³⁴ Dr. Blengini is monitoring the government's consideration of possible changes and provides updates to the Center.

Poland:

In May 1998, the Center participated in the 9^th Annual Palliative Medicine Advanced Course in Puszczykowo, Poland. This meeting was organized by the Palliative Care Department of the University of Medical Sciences in Poznan, Poland and the Sir Michael Sobell House in Oxford, UK. It was sponsored by the Polish Ministry of Health and the Stefan Batory Foundation of Warsaw. Dr. Colleau gave a workshop on "Education in cancer pain control and palliative care: a guide to resources." The workshop drew upon the recommendations of the World Health Organization and of the Institute of Medicine in the USA. to consider the key elements of professional competence in caring for patients at the end of life. A review of existing resources such as medical and nursing curricula, evidence-based clinical practice guidelines, consensus documents, and training programs was presented and discussed so that clinicians in Eastern Europe can take advantage of resources developed by others.

Two issues of Cancer Pain Release on the education of physicians and nurses in pain control and palliative care were made available to participants. Two monographs were developed by the Center for this meeting. "Availability of opioid analgesics for cancer pain relief" ³⁵ included sections on key publications of the United Nations on opioid availability, consumption data and trends, recommendations for action, primary resources and additional references. The second monograph, "Education in cancer pain control and palliative care: a guide to resources" ³⁶ contained an overview of professional education materials.

An outcome of this meeting was the Poznan Declaration of 1998 which gave the countries represented an opportunity to outline their goals in palliative care and outline steps to achieve them.³⁷

Yugoslavia:

During the 1999 International Association for the Study of Pain (IASP) conference, the Center was approached by a doctor from Belgrade who indicated that the recent war had cost them their capability to produce morphine for cancer patients. The Center agreed to make an effort to assist them and has initiated a number of contacts in 1999 to explore the options.

Latin American Region

Asian Region

African Region

North American Region

PPSG Home     Table of Contents    Top    Next section