Page 339 Guide to Pain Management in Low-Resource Settings

Resources for Ensuring Opioid Availability 327

Initiative of the Open Society Institute and the Lance Pearls of wisdom
Armstrong Foundation. Th e purpose of the IPPF is to
prepare leaders from low- and middle-income countries • Today’s regulatory requirements for “narcotic
to become change agents, and to develop plans to im- drugs” were developed long ago, well before pain
prove patient access to opioid pain medicines in their relief became a priority, before opioids were des-
countries. Fellows are selected through a competitive ignated essential medicines by the WHO, and at a
application process and spend a week in training with time when morphine was thought to cause addic-
the PPSG and other international experts. In some cas- tion in anyone exposed to it.
es, a representative of the NCA accompanies the Fellow • More recently, the WHO and the INCB have en-
to facilitate cooperation with the government drug reg- couraged governments to provide patients with
ulators. trouble-free access to oral opioid analgesics, and
Th e Fellows study the Internet course, diagram and the WHO has updated its defi nition of depen-
diagnose impediments in their country’s drug distribu- dence syndrome. Still, opioid analgesics continue
tion system, learn to use WHO tools to assess national to be inaccessible to most of the world’s popula-
drug control laws, and develop their own action plans tion.
to improve opioid availability and access. During the • Th e U.N. drug regulatory and health authorities
2-year fellowship, the Fellows implement their action have recognized the lack of availability of opioid
plans with technical assistance from the PPSG. Please analgesics, have urged governments to examine
visit the PPSG website for announcements, or go to national laws and regulations for barriers to opi-
http://www.painpolicy.wisc.edu/newslist.htm to sign up oid availability, and have asked health profession-
for email announcements from the PPSG. als and the IASP to work together to cooperate to

Table 2
Examples of cooperation between government and health care professionals
Government regulatory authorities can:
Inform health professionals about trends in drug traffi cking and abuse.
Explain the framework of drug control policy and administration in the country including how the estimated requirements for opioid
analgesics are prepared.
Create mechanisms such as a task force or commission to examine ways that national drug control policy and its administration could
help to improve availability and access while maintaining adequate control.
Endorse World Health Organization guidelines for management of pain.
Support national guidelines for pain management.
Inform health professionals about legal requirements and discuss any concerns.
Explore ways to provide an adequate number of outlets to maximize patient access.
Collaborate with other government organizations, e.g., in cancer and AIDS planning for services, and to support medical education,
education of patients and the general public.
Health professionals can:
Provide the government with information about the needs for various opioids for pain management and palliative care in the country.
Identify needs to address any barriers in the regulatory system.
Provide information about modern pain management, current knowledge about opioid analgesics in treating pain, and knowledge
and attitudinal barriers to their optimal use.
Demonstrate understanding of the international narcotic conventions and the obligation of governments to ensure adequate availabil-
ity of opioid analgesics, while also preventing abuse and diversion.
Provide information about WHO guidelines that can be used in self-assessment of the national opioids control policy.
Assist in providing information to estimate the amounts of various opioids that are needed to satisfy actual needs.
Identify impediments and weaknesses in the distribution system that lead to shortages.
Support the government’s eff orts to obtain adequate personnel to administer drug control functions under the Single Convention.
Explain health professionals’ concerns about prescription requirements and the possibility of investigation.