"Notice: this publication appears on the PPSG website with the express permission of the copyright holder, who should be consulted for further permission to reproduce."
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"Notice: this publication appears on the PPSG website with the express permission of the copyright holder, who should be consulted for further permission to reproduce." |
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Executive Summary
The World Health Organization (WHO) has determined that the inadequate management of pain due to cancer is a serious public health problem in the world. Worldwide, there are 10 million new cases of cancer and 6 million deaths annually from this noncommunicable disease (1). Twenty years from now, the global burden of cancer will double. The incidence of cancer, presently greatest in developed countries, will shift to developing countries, reflecting better prevention strategies in the developed world. The WHO Programme on Cancer Control has estimated that by the year 2020, approximately 70% of the annual 20 million new cancer cases will occur in developing countries (1), where most patients are diagnosed when the disease is already in the late stages. Pain is prevalent in cancer, but especially in the late stages, near the end of life.
Tragically, cancer pain frequently goes untreated; when it is treated, relief is often inadequate. Yet, the WHO has demonstrated that most, if not all, pain due to cancer could be relieved if we implemented existing medical knowledge and treatments. There is a treatment gap: it is the difference between what can be done, and what is done about cancer pain. The treatment gap can be narrowed by educating and training health care workers, and by increasing access to pain relief and palliative care services. However, much of the treatment gap, especially in developing countries, is defined by the inadequate availability and use of pain medications, in particular the opioid analgesics.
Although there are many drug and non-drug pain treatments, the opioid analgesics such as codeine and morphine are absolutely necessary for the management of pain due to cancer. When cancer pain is moderate to severe, there is no substitute for opioids in the therapeutic group of morphine. The International Narcotics Control Board (INCB),[1] the international body that monitors, inter alia, global availability of narcotic drugs, emphasizes that these drugs must be available for pain relief.
Opioids are classified as narcotic drugs because they have a potential for abuse. As a consequence, they are regulated by international treaties and national drug control policies. The INCB, the WHO and national governments report that opioids are not sufficiently available for medical purposes. There are a number of reasons, including the low priority for pain management in health care systems, greatly exaggerated fears of addiction, overly restrictive national drug control policies, and problems in procurement, manufacture and distribution of opioids.
In some countries, governments and health care professionals have been working together to improve cancer pain management and palliative care; some have begun to identify and correct overly restrictive regulatory control over the medical use of opioid analgesics. Other countries have yet to address these matters. These Guidelines can be used by governments to determine whether their national drug control policies have established the legal and administrative framework to ensure the medical availability of opioid analgesics, according to international treaties and the recommendations of the INCB and the WHO.
A 1995 INCB report (3) stated:
"...an efficient national drug control regime must involve not only a programme to prevent illicit trafficking and diversion, but also a programme to ensure the adequate availability of narcotic drugs for medical and scientific purposes" (p.14).
[1] The International Narcotics Control Board is an independent treaty-based body that monitors implementation of the Single Convention on Narcotic Drugs, 1961, and other related treaties. For a description of the Board and its activities see: INCB, 1999 (2).