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 to support its work with governmental and non-governmental organizations and individuals who are working to improve pain relief. The database consists of (1) statistics describing the medical consumption of morphine and other principal opioids for all countries that report to the INCB; (2) population data, by country, from the United Nations Department of Economic and Social Affairs; and (3) human development index (HDI) data, a composite score of a country’s life expectancy at birth, level of education, and standard of living, from the United Nations Development Programme. These data allow the Center to monitor opioid consumption trends, to identify progress and problems in improving pain relief, to examine correlations between opioid consumption and HDI, and to inform health-care professionals and government officials about their country’s trends in use of opioids. The Center’s analysis of these data has been reported in numerous publications, monographs,1,2 and conference presentations and posters.

Education:
The Center has organized and participated in meetings and educational programs that bring together representatives from government, drug control, cancer, AIDS, palliative care, and medical education in several countries, including India, Italy, Japan, and Turkey. Such efforts, and continued networking of professionals representing government and medicine, will help to develop awareness about the policy and infrastructure changes necessary to ensure opioid availability for pain management and palliative care. The Center has developed specialized presentations that explain the principles of opioid availability, their origins in international narcotics control treaties, and how to implement them. These presentations can be helpful in understanding and applying a drug control policy framework that has the capability of ensuring opioid availability. The Center has produced a number of monographs for distribution at national, regional and international meetings to provide participants with information about opioid analgesic consumption trends and how to access informational key resources (see Bibliography).

Policy Evaluation:
The Center has the capability to evaluate national opioids control policy. This work is based on a central principle of “balance,” that government policies to prevent misuse and diversion of controlled substances should not interfere with their use for the relief of pain.3-5 Using this central principle, the Center helped to prepare WHO Self-Assessment Guidelines to encourage national governments to achieve better pain management by identifying and overcoming regulatory and other barriers to opioid availability.5,6 The WHO Guidelines can be used to develop balanced national drug control policies, and are intended for those who make national drug control policy, as well as those who implement it. The WHO Guidelines may also be used by health-care professionals and their organizations to establish cooperation with governments and facilitate education about the rational use 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 identify and address policy problems.

Communications:
The Center continues to expand dissemination of its work to a wide international audience of health-care practitioners and government officials through publications, conference participation, networking on the Internet, access to websites, and periodic email contact with collaborators. In 2001, we communicated via email to 225 colleagues around the world, notifying them of the new WHO Guidelines to improve opioid availability in the world, an article published in Lancet that reported outcomes from a WHO Demonstration Project in Calicut, India, and a joint statement issued by the U.S. Drug Enforcement Administration and 21 U.S. health and pain organizations about the need for balance when addressing drug diversion.

Collaboration:
The Center is committed to a collaborative process. For example, the Center’s collaborative efforts have been conducted with government and non-government organizations in India. The aim of collaboration is to develop the relationships between government and non-government organizations that are necessary to evaluate and improve policies governing opioid availability. Other examples of collaborative efforts appear throughout this report.

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