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Unavailability
of opioid analgesics David
E. Joranson The World Health Organization (WHO) has repeatedly emphasized that relief of severe pain is possible if we implement what we already know about pain and symptom management. This means making use of the drugs that we already have, in particular the opioid analgesics, such as morphine, that are essential for the relief of pain and suffering in patients with cancer and HIV/AIDS.1-3 Indeed, the WHO uses national morphine consumption statistics as a rough indicator of progress to improve cancer pain relief.3 The absence of opioid analgesics has serious consequences for people with severe pain. If the use of opioid pain relieving medicines remains as inadequate as it is today, unnecessary pain and suffering will continue. In Africa, where there have been a few reports about the status of opioid availability,4-6 how does the consumption of morphine compare to the rest of the world? In 1999, the mean consumption of morphine for all the countries of the world was only 5.9 milligrams per capita (mg/capita). The top consumers were twelve industrialized countries that used from 20 to 75 mg/capita. The rest of the countries used less than 20 mg/capita. The mean consumption of morphine for the African region was the lowest of all the WHO regions of the world, at 0.7 mg/capita. South Africa ranked the highest at 3.4 mg/capita. Of the five countries participating in the WHO Demonstration Project for Palliative Care, Ethiopia and Zimbabwe did not report statistics for 1999. Three countries did report statistics: Botswana, 0.1 mg/capita; Uganda, 0.008 mg/capita; and Tanzania, 0.001 mg/capita. The barriers to improving opioid availability and patient access are many and complex; these include overly restrictive narcotics regulations, concerns about diversion, fears about the consequences of unintentional errors, and greatly exaggerated fears that patients will become addicted. This year, the International Narcotics Control Board called on all governments and the medical profession to review national narcotics regulations and to identify impediments to patients’ access to essential pain-relieving medications. The World Health Organization has prepared a set of guidelines exactly for that task, titled “Achieving Balance in National Opioids Control Policies”7 These new guidelines are available on the internet at (http://www.medsch.wisc.edu/painpolicy/publicat/00whoabi/00whoabi.htm). They will be used during the workshop “A Community Health Approach to Palliative Care for HIV/AIDS and Cancer Patients in Africa” in Gabarone, Botswana from 9-12 July 2002, to help identify the steps that should be taken to remove undue regulatory constraints on availability and patient access to pain medications for cancer and HIV/AIDS.
(1) World Health Organization. Cancer Pain Relief. Geneva,
Switzerland: World Health Organization; 1986.
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