I. Work Performed in Relation to the Terms of Reference
A. Develop Methods and Procedures
The Center has developed methods and procedures in several areas to implement its Terms of Reference. These areas include data collection, education, policy evaluation, communications, and collaboration.
Data collection:
The Center maintains an international
database of opioid consumption data and makes these data available to numerous
governmental and non-governmental organizations and individuals who are working
to improve pain relief. The Center receives data on the medical consumption of
morphine and other principal opioids for all countries that report to the
International Narcotics Control Board (INCB). These data allow the Center to
monitor consumption trends and progress to improve pain relief, to identify
problem areas, and to educate health-care professionals and government officials
from any country about their past and present use of opioids. The Center’s
analysis of these data has been reported in numerous publications, monographs,2,3
and conference presentations and posters.
Education:
The Center has organized or participated in meetings and educational programs that bring together
representatives from government, cancer control, palliative care, and education within several countries,
including France, Costa Rica, Andean countries of Latin America, India, Italy, Luxembourg, and
Slovenia. Such efforts, and continued networking of professionals representing government and
medicine, will help create national infrastructures to ensure opioid availability and enhance the priority
of a country's pain management and palliative care in the health system. The Center has developed
presentations that explain the principles of opioid availability and how they are derived from
international sources of authority, such as the international narcotics control treaties, the World Health
Organization (WHO) and the INCB. These presentations can be helpful in understanding the policy
framework for ensuring opioid availability. The Center has produced a number of monographs for
distribution at national and international meetings to provide participants with information about opioid
analgesic consumption trends and key resources (see Bibliography).
Policy Evaluation:
The Center evaluates policy at both the national and international levels. This work is based on a central
principle of "balance," that government policies intended to prevent misuse and diversion of controlled
substances should not interfere with their use for the relief of pain.4,5 From this central principle, the
Center has developed 1) a set of evaluation criteria against which U.S. federal and state policies have
been examined to identify provisions that may enhance or impede pain management,6 and 2) WHO Self-Assessment Guidelines to encourage national governments to achieve better pain management by
identifying and overcoming regulatory and other barriers to opioid availability.5 The WHO Guidelines
can be used to develop balanced national (including states, provinces or territories) drug control policies.
This document, which was issued by WHO in 2000, is intended for those who make national drug control
policy, as well as those who implement it. It may also be used by health-care professionals and their
organizations to encourage cooperation with governments and to facilitate further education about
ensuring the availability of pain medications. The Center has also developed a procedure to "diagnose"
and "treat" barriers to pain management and opioid availability, applying a medical model to policy
problems.
Communications:
The Center is improving its capacity to disseminate its work to a wide international audience through
publications, conference participation, networking on the Internet, websites, and frequent email contact
with collaborators.
Collaboration:
The Center is committed to a collaborative process. The Center's collaborative policy evaluation efforts
have been conducted with WHO-Geneva in drafting and finalizing new WHO Guidelines for evaluating
national narcotics control policy for "balance"5 in India, and with the Pan American Health Organization
(PAHO) to sponsor a workshop in the Andean countries. The aim of collaboration is to establish the
relationships between government and non-government organizations that are necessary to evaluate and
improve policies governing opioid availability. Examples of collaborative efforts appear throughout this
report.