France
The Center was invited to provide a speaker at the European Federation of the International Association for the Study of Pain Chapters meeting, "Pain in Europe III: Advances in Pain Research and Therapy," in Nice, France in September 2000. The purpose of the presentation was to present the data and implications from a study on the medical use and abuse of opioid analgesics in the United States that was published in the Journal of the American Medical Association ¹³ in April 2000. The study results demonstrated that from 1990-1996, increased medical use of opioid pain medications had not led to an increase in their abuse.

Italy
Discussions with colleagues from the European Association of Palliative Care (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 provided Dr. Blengini with information and consultation to strengthen his ability to provide expert guidance to a national commission that studied 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.¹⁴ Dr. Blengini is monitoring the government’s consideration of possible changes and provides updates to the Center.

In 2000, the Italian government, with assistance from the national commission and Special Committee, drafted legislation that would simplify its prescription requirements. The legislation would simplify the complex, three-part prescription form, requiring completion of the information only once instead of three times; increase the amount allowed to be prescribed on a single prescription form from an 8-day supply to a one-month supply; allow physicians to prescribe two drugs or two dosage units (instead of one) on a single prescription form; and decrease the sanctions for inadvertent technical errors made in prescribing or dispensing.

Throughout the process of change in Italy, the Center provided technical assistance when requested. In 2000, the Director of the Center was requested to submit a videotaped testimony for a national meeting called by the Minister of Health, Prof. Veronesi. The five-minute testimony, which expressed encouragement for the efforts in Italy, discussed the regulatory impediments to opioid availability and explained two international standards that provide strong and unequivocal support 
and direction for eliminating regulatory barriers.¹⁵

Luxembourg
The Center was invited to participate as faculty in the First National Congress of Palliative Care in Luxembourg, March 9-11, 2000. Dr. Colleau gave a plenary lecture in French on "The place of palliative care in the 21st century: International priorities and personal commitment" [La place des soins palliatifs au 21ème siècle: Priorités internationales et engagement individuel]. The Center also participated in a panel discussion on the topic: "Palliative care: Patients rights and society’s responsibilities" [Soins palliatifs: droit du malade -- Devoir de la société].

Slovenia
The Center was invited to participate as faculty in the Schweitzer Regional Conference on Hospice and Palliative Care, sponsored in cooperation with the Project on Death in America of the Open Society Institute, in Bled, Slovenia June 14-16, 2000. Considerable effort was dedicated to preparations, including development of a slide presentation which provided information and addressed issues relevant to countries in Eastern Europe, and a variety of resources published by the Center, including several issues of Cancer Pain Release. The Director presented on the topic of "Drug availability and regulation," summarizing the extremely low consumption of opioids in the participating countries, and offering steps for diagnosing and correcting problems of opioid availability. This presentation generated considerable discussion and resulted in participants taking the initiative to consult with their governments about the situation. The Director also chaired and participated in a panel discussion on "Public education & the role of the media," pointing out that the public receives much of its health information from the media and leading a discussion of the audience with the panel members of how to work with the media to get our messages to the public. The Center initiated discussions with the organizers of the conference about the possibility of organizing a workshop in Eastern Europe that would bring together representatives of national governments and palliative care to explore ways of improving opioid availability for palliative care.

The following communication was received from the conference organizers:

"I would like to thank you for your excellent contribution to Schweitzer Conference on Hospice and Palliative Care: A Regional Perspective, which was held in Bled, Slovenia. After we have collected and evaluated responses from participants we can tell you that the conference was a success also because of your help. I would like to thank you for sharing your knowledge, experiences and personal qualities with us. I am looking very much forward to our future cooperation. I respect your voluntarism and enthusiasm and would also like to thank you for inspiration and support for our future activities in the field of End of Life and Palliative Care issues."¹⁶