II. Relationship Between the Center and WHO

A. Collaboration between the Center and WHO Headquarters

Visit by WHO:
On January 30, 1998, the Center hosted Dr. Karol Sikora, Director of the WHO Cancer Unit which had been transferred from Geneva to the International Agency for Cancer Research in Lyon, France. The Center discussed with Dr. Sikora how the burden of cancer is shifting to developing countries, and how difficult it is for most cancer patients in the world to obtain opioid analgesics due to restrictive regulation of narcotic drugs. The Center described the methods it uses to improve the situation. The briefing also addressed the communications terms of reference of the Center, the publication of Cancer Pain Release and the need for financial support.

Visit by WHO:
On November 29, 1999, the Center was pleased to have a visit from Ambassador Tom Loftus, WHO Special Advisor to the Director-General. As with Dr. Sikora, the Center discussed the shifting burden of cancer to developing countries, the difficulty of obtaining opioid analgesics, the methods the Center is developing to improve the situation, the communications terms of reference of the Center, the publication of Cancer Pain Release, and the need for support. Following the meeting, Ambassador Loftus provided the Director-General of WHO with a summary of his visit.

New WHO Guidelines on Opioid Availability:
In 1998, the Center had proposed to WHO the development of guidelines which could be used by governments and health care professionals to evaluate national narcotics control policy for "Balance," i.e., to determine if a government's national narcotics control law, regulations and administration have the capability of ensuring the availability of opioid analgesics as is required of governments which are parties to the Single Convention on Narcotic Drugs, 1961. Following submission of a proposal to Mr. Tokuo Yoshida of the WHO unit for Medicines, Essential Drugs and Medicines Policy, a contract was issued to the Center to develop the guidelines. The Center staff produced a draft, and Mr. Yoshida, in cooperation with the Center, sponsored an expert working group to review the guidelines. The working group met in Madison, Wisconsin, USA. in November, 1999; it was comprised of the co-sponsors, Mr. Yoshida, Mr. Joranson (chairperson), and representatives from countries and organizations, including Mrs. Carmen Selva (International Narcotics Control Board, Vienna), Ms. Liliana De Lima (Pan American Health Organization), Mr. Romesh Bhattacharji (Narcotics Commissioner of India), Ms. Gu Wei-ping (State Drug Administration, China), Dr. Claudio Blengini (Pain specialist, Italy), Dr. Philip Emafo (International Narcotics Control Board, Nigeria), and Dr. Alan Nixon (Palliative care specialist, Saudi Arabia). The working group provided useful comments. The draft, Achieving balance in national drug control policy: guidelines for self-assessment, was revised and submitted to the WHO for publication in 2000.

B. Collaboration between the Center and WHO Regional Offices

Pan American Health Organization (PAHO), Washington D.C.:
The Center was invited to participate in a PAHO planning workshop for cancer pain relief and palliative care in 1996. This initiative has resulted in plans for Latin American demonstration projects, and in 1998 the Center proposed a workshop with governments and representatives of cancer control and palliative care on opioid availability in Latin America. The Center was instrumental in locating funds to help cover the costs of the workshop which will be held in 2000 or 2001.

Western Pacific Regional Office (WPRO), Manila:
In 1998, the Center participated as faculty in a meeting in Saitama, Japan sponsored by the WHO Western Pacific Regional Office, Manila. The title of the meeting was "Workshop on Strengthening Health Professional Education in Cancer Pain Relief and Development of Palliative Care Expertise." Mr. Joranson presented a lecture on the need to ensure availability of opioid analgesics for cancer pain relief and recommended that palliative care curricula always include material on opioid availability. A monograph was presented on "Availability of opioid analgesics for cancer pain relief" ⁴⁷ in the region. Experts who participated represented Cambodia, China, Fiji, Korea, Laos, Malaysia, Mongolia, Papua New Guinea, Philippines, Singapore, and Vietnam. A report, Workshop on strengthening health professional education in cancer pain relief and development of palliative care expertise,⁴⁸ is available from WPRO .

In 1999, the WHO Western Pacific Regional Office requested Mr. Joranson to serve for approximately one month as a Temporary Consultant to conduct, in cooperation with the Ministry of Health in Malaysia, a review of opioid availability for cancer pain relief according to the following terms of reference:

1) to review relevant legislation and drug regulation on analgesics, particularly for medical use of patients with cancer and other terminal illnesses;

2) to evaluate supply and distribution of the pain relief drug, and use of the pain relief drug for cancer patients, particularly morphine in health delivery system (hospitals, policlinics, and communities);

3) to conduct a workshop on the development of cancer pain relief for drug regulators and hospital administrators;

4) to advise the government on improvement of pain relief drug availability for use by cancer patients and development of cancer pain relief programme by improving drug regulations and administration.

Prior to the visit, Mr. Joranson was briefed at WPRO offices in Manila by Dr. Han Tieru and WPRO staff, and was debriefed upon return. Mr. Joranson made a presentation about opioid availability to a national conference on palliative care in Penang,⁴⁹ and participated in a workshop on opioid availability for palliative care specially organized by the Ministry of Health to obtain information and perspective about opioid regulation and availability in Malaysia.⁵⁰ Copies of Cancer Pain Release and other resource materials were distributed to conference and workshop participants. A mission report is available.⁵¹

The WPRO has expressed interest in sponsoring a workshop on opioid availability for Asian countries, similar to the one that is being sponsored by PAHO for Latin American countries. The Center strongly endorses this activity but lacks the funds.

South East Asian Regional Office, New Delhi:
The Center informed SEARO of its activities in India with the government, IAPC and the PPCS, and the WHO Demonstration Project. The Center visited the office in 1997, 1998 and 1999, requesting on various occasions that the regional office support the workshops that the Center and IAPC were organizing as well as the work of the PPCS including training of doctors about how to use morphine. At the request of SEARO, a proposal was submitted but it was not funded.⁵²

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