C. National Policies, Opioid Availability and Educational Programs
The Center is proactive in monitoring and participating in the global development of cancer pain relief and palliative care according to WHO’s three measures of national policy, opioid availability, and educational programs. The following section reports on these activities in several regions and countries.
1. Europe
Italy
Treatment of cancer pain in Italy has been reported to be inadequate for more
than a decade. The problem has been documented in the literature, by INCB reports
that show Italy's low consumption of morphine, and by INCB statements reflecting
concern that pain medications are not adequately available to suffering cancer
patients. The reasons for under-treatment are many, and include overly restrictive
regulations that inhibit the prescribing of opioid analgesics. In 1998, our
Center began collaborating with Dr. Claudio Blengini by providing technical
assistance that included opioid consumption statistics, and our initial efforts
were published in an Italian medical journal.10
Dr. Blengini was an appointed member of the Ministry of Health workgroup that
was established in 1999 to address inadequate cancer pain management, and which
issued a proposal in 2000 to reform national policy, including simplification
of opioid prescribing requirements. To assist in the workgroup’s efforts,
the Center’s Director provided videotape testimony for a national meeting
called by the Minister of Health.11
The proposal, which was adopted by Parliament in January 2001
and effective March 6, 2001, includes the following provisions:
(1) a new simplified prescription form that is more similar in appearance to
the standard prescription form, thereby reducing the historical stigma associated
with pain medications; (2) physicians can prescribe a one-month supply (instead
of an 8-day supply) of pain medication on a single prescription form; (3) physicians
are allowed to prescribe two drugs or two dosage units (instead of one) on a
single prescription form; and (4) sanctions for inadvertent technical errors
made in prescribing or dispensing have been lessened. The changes, when fully
implemented, will be important steps toward relieving cancer pain. An article
by Dr. Claudio Blengini and staff members of the Center was submitted to the
European Journal of Cancer Care in 2001 and is in press.12
Turkey
The Director of the Center was invited to participate in a meeting of international
pain experts in Istanbul in June 2001. The main topic discussed
was the barrier to treatment of pain called “opiophobia.” The panel
of experts consisted of pain specialists and health policy scholars from Austria,
France, Germany, Japan, Turkey, and the U.S. They discussed the impact of fear
of opioids on the clinical use of pain medications, and called for a balanced
approach to drugs control that allows for adequate access to the medications.
A report on this meeting was published in 2002.13
2. Asia
Japan
The Japanese International Corporation for Welfare Services (JICWELS) seminar,
sponsored annually by the Japanese government, provides information on drug
control policy and administration for national drug regulators from Asian countries.
As in the past, the WHO-Geneva Essential Drugs and Medicines Department sponsored
the Director’s attendance in Tokyo as a Temporary Advisor in July 2001.
In this capacity, he gave a presentation on the obligation of government, and
the policy and methods for ensuring availability of opioids for medical and
scientific purposes.2
The countries in attendance were: Cambodia, China, Indonesia, Japan, Laos, Malaysia,
Myanmar, Nepal, the Philippines, Sri Lanka, Thailand, and Viet Nam.