Introduction

IMPROVING CANCER PAIN RELIEF
IN THE WORLD: 2000

A Report

World Health Organization
Collaborating Center for Policy and
Communications in Cancer Care

Sponsored by

The Pain & Policy Studies Group
University of Wisconsin Comprehensive Cancer Center
The Medical School
Madison, Wisconsin USA
www.medsch.wisc.edu/painpolicy

September 2001

Table of Contents

Executive Summary The Center and its WHO Terms of Reference Staff Members Acknowledgements

Executive Summary

This report summarizes the work of the World Health Organization (WHO) Collaborating Center for Policy and Communications in Cancer Care. The Pan American Health Organization (PAHO) designated the Center in 1995. The Center is sponsored by the Pain & Policy Studies Group of the University of Wisconsin Comprehensive Cancer Center in the Medical School, Madison, Wisconsin, U.S.A.

In 2000, the Center collaborated with WHO - Geneva, Department of Essential Drugs & Medicines Policy (Project Officer: Mr. T. Yoshida) to finalize and issue Achieving Balance in National Opioids Control Policy: Guidelines for Assessment ("WHO Guidelines"). The WHO Guidelines can 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, 1961.¹

The Center, the Non-Communicable Diseases Program of PAHO, and the WHO Program of Essential Drugs and Medicines Policy in Geneva sponsored a workshop on opioid availability for palliative care in December 2000 in Quito, Ecuador. Teams of health professionals attended, representing cancer control, palliative care, essential drugs, and narcotics control from six Andean countries: Bolivia, Chile, Colombia, Ecuador, Perú, and Venezuela. The goal of the workshop was to develop an action plan to improve opioid availability in each country. Using the new WHO Guidelines as a framework, participants discussed the purposes and functions of international treaties and national drug control laws, and developed improved mutual understanding of the needs for opioids for palliative care.

In 2000, the Center consulted with the International Narcotics Control Board (INCB) about the international and national opioid availability situation and used INCB opioid consumption data to monitor progress or lack of it in a number of countries. The Center collaborated with national governments on a range of projects, as well as with non-governmental organizations in Asia, Latin America and Europe.

The Center sponsors a WHO Demonstration Project in India to show how countries can make opioids available for the relief of pain in dying patients living at home, without diversion and abuse. In addition, four more morphine availability workshops were held in India in 2000 to simplify state regulations.

The Center accomplishes its policy work through a program of research, development, demonstration, monitoring and evaluation. The Center develops methods, procedures and models that can be used to identify barriers to opioid availability, diagnose regulatory problems, make changes in national and state policy, and monitor outcomes.

The Center accomplishes its communications work primarily through the publication of Cancer Pain Release, a quarterly WHO newsletter that provides health professionals, policy makers, and regulators throughout the world with updates on issues and developments in the field. Cancer Pain Release has a world-wide circulation of 100,000 in 160 countries and is inserted in several medical journals.

Every year, the Center also participates in a number of international and national conferences and strategy meetings for health professionals and government officials, and provides technical assistance to government and non-government organizations. The Center maintains two websites and promotes worldwide access to better understand the principles that should guide national narcotics control policy.

Madison, Wisconsin, USA September 20, 2001

David E. Joranson Director