8 October 2016
Living and dying in pain: It doesn’t
have to happen
The theme of World Hospice andPalliative Care Day 2016 is: ‘Living and dying in pain: It doesn’t
have to happen’.
75% of the world population does not
have adequate access to controlled medications for pain relief.
As a result, millions of people suffer
from pain which is avoidable and could be managed with proper access
to the correct medications.
Various barriers prevent people in need
from accessing these essential medications.
The World Day campaign will examine
three major barriers for access to pain relief, and provide case
studies, advocacy resources, and examples of good practice to help
address these.
Restrictive regulations
- Unduly restrictive regulations limit access to pain relief and palliative care for people and families in need
- Balance is needed to ensure access to essential controlled medicines for pain management while ensuring that they are not used for illicit purposes
- Pain management is the right of the person with pain
- Pain management without significant risk of dependence is possible through education of healthcare workers and patients
- Many national laws and regulations exceed the measures required by the Single Convention on Narcotic Drugs
- Examples:
- Most countries limit morphine prescriptions to 10 mg injectable twice daily, guaranteeing that pain will not be effectively controlled.
- In some jurisdictions, physicians can be charged with a crime should they make documentation errors that are not prosecuted elsewhere.
- Restrictions and expensive requirements discourage pharmaceutical companies from producing morphine, and pharmacies from stocking it
- Legally available morphine is difficult, if not impossible, to obtain in some countries.
- This forces some patients or their family members to buy opioids through illegal channels, which puts them in danger of arrest and prosecution.
- How is this being addressed?
- Romania has removed all excessive regulatory restrictions on opioid prescribing with no reported cases of misuse.
- In Kerala, India, a two-year study of people being treated for pain with oral morphine found no instances of misuse or diversion
- In Uganda specially trained nurses are legally allowed to prescribe liquid morphine solution for people accessing palliative care.
- Oral morphine and other WHO essential palliative care medications should be legally available and accessible in all countries
Poor education
- Opiophobia is the fear in the health professions of prescribing opioid medications which prevents people from receiving pain relief
- Examples
- Doctors and nurses are not educated about pain management and prescribing morphine or are taught that morphine and other opioids are dangerous and should be used as little as possible
- Doctors and nurses are not taught how to assess and manage pain
- There is fear that anyone using opioids will become addicted/dependent
- In most countries, there is no way to qualify as a palliative care specialist and no inclusion of palliative care training in medical or nursing schools, as well as no continuing education for health professionals to counteract opiophobia.
- How is this being addressed?
- An increasing number of countries are now including palliative care education for medical and nursing students
- The Hospice Africa Uganda morphine initiators’ course at the Institute of Hospice and Palliative Care in Africa trains healthcare workers from all over Africa in how to safely prescribe and administer morphine.
- The University of Cape Town runs a Master’s course and Postgraduate Diploma in Palliative Medicine which use distance learning so that busy professionals can expand access to palliative care and pain management, as well as the research base on this topic.
- In Tajikistan a course on pain relief and palliative care is being developed for police professionals.
- Unreasonable fear of opioid use leads to increased suffering worldwide
Economic barriers
- Morphine is inexpensive to produce yet expensive to bring to market in many places with unduly restrictive regulations. As a result the pharmaceutical industry has no incentive to produce and market oral morphine for pain management.
- Examples
- The profit margin for oral morphine tablets is too low to be of interest to most pharmaceutical producers
- Higher cost analgesics such as fentanyl are easier to obtain in many countries than oral morphine, which is the standard of pain management in palliative care.
- How is this being addressed?
- In Colombia the Fondo Nacional de Estupefacientes (FNE) is responsible for the purchase and national distribution of opioid medications (morphine, hydromorphone, and methadone) in the country.
- A morphine manifesto (http://palliumindia.org/manifesto/) has been signed by 64 organizations calling for universal availability of immediate release morphine.
- All people with life threatening illness and their families need and deserve comfort care and pain management through palliative care services.
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