Page 337 Guide to Pain Management in Low-Resource Settings

Resources for Ensuring Opioid Availability 325

manufactured. Th e “estimates system” administered by drug control laws and regulations, how these are im-
the NCA and the INCB is designed to estimate unmet plemented in the distribution system, how they can be
needs for opioids and then authorize their acquisition. evaluated, and then working with government to make
Each year, the NCA prepares and submits to the INCB necessary changes in policy and administration.
the estimated requirements of the quantities of each With support from the National Hospice and Pal-
opioid that will be needed in the country. liative Care Organization and the Foundation for Hospices
Only when the national estimate is increased or ex- in Sub-Saharan Africa, the PPSG developed an Internet
panded to include other opioids can there be a change course titled “Increasing patient access to pain medicines
in the overall amounts that are imported, manufactured, around the world: a framework to improve national poli-
distributed, and dispensed to patients. However, if there cies that govern drug distribution.” Th e course was de-
is little public interest in obtaining pain relief or medical veloped to make available this specialized information to
interest in providing it, there may be little justifi cation clinicians, government administrators, drug regulatory
for increasing availability. personnel, national health policy advisors, health policy
When controlled drugs are needed for humanitarian scholars, and to those who develop clinical guidelines and
emergencies, the usual time-consuming regulatory pro- training materials for pain management and palliative care.
cedures governing exports and imports can be abbrevi- Th e course has seven lessons, each with required
ated to expedite increased availability and access; further readings and extensive citations (see Table 1). Th e
information is available from the INCB and the WHO. course explains why patients and clinicians have a right
to expect that their national drug regulatory system
Are there recommendations should make opioids available, and explains how this
for educators and professional goal can be accomplished.

organizations to address opioid
availability problems? Do health professionals already
have skills that can be used to
Yes. Th e INCB, in consultation with the WHO, has rec- address opioid availability?
ommended a strong role for educational institutions
and nongovernmental health care organizations—in- If you have medical training, you already have relevant
cluding the International Association for the Study of medical knowledge that can be applied in the drug reg-
Pain (IASP)—to teach students in health care profes- ulatory policy and systems arena. For example, you may
sions and licensed practitioners about the use of opioid appreciate the need for pain relief among patients with
analgesics, their control, and correct use of terms related various diseases and conditions. You may know about
to dependence. Furthermore, health care professionals the drugs and their uses. Th e medical model is also a
and their organizations have been requested to establish solid problem-solving approach that can be applied to
ongoing communication with their governments about the diagnosis of barriers to opioid availability and ac-
unmet needs for opioid analgesics and to help identify cess, and to formulating action strategies, or treatments,
impediments to availability and access. as if the opioid distribution system in your country is
your patient. Using this knowledge and skill, you can
become an eff ective leader to work with government to
Where can a clinician fi nd examine, diagnose, and then decide on and implement
information about how to improve the treatments necessary to correct the problems.
opioid availability and access?

Although there are numerous guidelines and educa- What tools are available to help
tional curricula that address pain and palliative care, diagnose regulatory problems in
clinical training materials often do not describe the drug my country?
control system and the steps necessary to obtain and
distribute opioid analgesics. Obtaining and sustaining Information about drug control policy and systems
access to opioid analgesics in any country depends on barriers is often new to the health professional, so the
learning about the context of international and national WHO has published Cancer Pain Relief with a Guide