Page 340 Guide to Pain Management in Low-Resource Settings

328 David E. Joranson

educate health workers and to ensure adequate rights advocates understand that working with govern-
patient access to pain relief. ment is necessary. Th e work outlined here to evaluate
• Pain and palliative care experts report that the and reform outdated drug control policies is an integral
absence of a clear statement about the govern- part of making the human right to pain relief a reality.
mental obligation under international agreements
to ensure adequate opioid availability in national References
laws makes it diffi cult to convince regulators.
PPSG studies show that the U.N. model drug [1] De Lima L, Krakauer EL, Lorenz K, Praill D, Macdonald N, Doyle D.
Ensuring palliative medicine availability: the development of the IAH-
control laws that should provide balanced guid- PC list of essential medicines for palliative care. J Pain Symptom Man-
ance to governments also lack such language. age 2007;33:521–6.
[2] Foley KM, Wagner JL, Joranson DE, Gelband H. Pain control for peo-
• Traditionally, most countries have used pethi- ple with cancer and AIDS. In: Jamison DT, Breman JG, Measham AR,
Alleyne G, Claeson M, Evans DB, editors. Disease control priorities in
dine (meperidine) for pain relief, with the thought developing countries, 2nd edition. New York: Oxford University Press;
that such a short-acting opioid would be less ad- 2006. p. 981–93. Available at: http://fi les.dcp2.org/pdf/DCP/DCP52.pdf.
[3] Human Rights Watch. Please do not make us suff er anymore. March 3,
dictive. But since the regulatory controls for 2009. Available at: http://www.hrw.org.
morphine and other strong opioids are the same [4] International Narcotics Control Board. Report of the International Nar-
cotics Control Board for 1995. Availability of opiates for medical needs.
as for pethidine, it should be possible for health New York: United Nations; 1996. Available at: www.incb.org/pdf/e/
ar/1995/suppl1en.pdf.
professionals and the NCA to fi gure out how [5] Joranson DE, Rajagopal MR, Gilson AM. Improving access to opi-
to make available other opioids where they are oid analgesics for palliative care in India. J Pain Symptom Man-
age 2002;24:152–9. Available at: http://www.painpolicy.wisc.edu/
needed. publicat/02jpsm3/index.htm.
• Th e resources provided in this chapter off er a [6] Joranson DE, Ryan KM. Ensuring opioid availability: methods and re-
sources. J Pain Symptom Manage 2007;33:527–32. Available at: www.
starting point as well as encouragement to work painpolicy.wisc.edu/publicat/07jpsm/07jpsm.pdf.
[7] Joranson DE, Ryan KM, Maurer MA. Opioid policy, availability, and
with colleagues, professional organizations, and access in developing and nonindustrialized countries. In: Fishman SM,
government to correct the conditions that block Ballantyne JC, Rathmell JP, editors. Bonica’s management of pain, 4th
edition. Baltimore: Lippincott Williams & Wilkins; 2010. p. 194–208.
eff orts to relieve pain and suff ering. [8] Pain and Policy Studies Group. Internet course: Increasing patient ac-
cess to pain medicines around the world: a framework to improve na-
tional policies that govern drug distribution. University of Wisconsin
In closing, here are a few tips: Paul P. Carbone Comprehensive Cancer Center. Available at: www.pain-
policy.wisc.edu/on-line_course/welcome.htm.
[9] Rajagopal MR, Joranson DE, Gilson AM. Medical use, misuse, and di-
Be alert to new opportunities and resources. Th ere may version of opioids in India. Lancet. 2001; 358(9276):139–143.
[10] World Health Organization. Essential medicines. Geneva: World
be opportunities in your country for synergistic part- Health Organization; 2005. Available at: www.who.int/topics/essential_
medicines/en.
nerships with government and nongovernment public [11] World Health Organization. Cancer pain relief: with a guide to opioid
health organizations that advocate the use of metha- availability, 2nd edition. Geneva: World Health Organization; 1996.
Available at: http://whqlibdoc.who.int/publications/9241544821.pdf.
done for treatment of intravenous drug users to reduce [12] World Health Organization. Achieving balance in national opi-
the spread of HIV/AIDS. Th e international controls on oids control policy: guidelines for assessment. Geneva: World
Health Organization; 2000. Available at: www.painpolicy.wisc.edu/
morphine and methadone are the same, and the regu- publicat/00whoabi/00whoabi.htm.
[13] World Health Organization. Access to controlled medications program.
latory steps to make them available and accessible in a Geneva: World Health Organization; 2007. Available at: www.who.int/
country should be similar to those for opioid analgesics. medicines/areas/quality_safety/access_to_controlled_medications_
brnote_english.pdf.
Th e WHO is developing an Access to Controlled
Medicines Program to provide additional support for ef-
Recommended websites
forts to improve medical access to opioid analgesics as
well as other essential medicines that are controlled drugs.
Pain & Policy Studies Group: www.painpolicy.wisc.edu/
Pain relief is becoming recognized as a human World Health Organization: www.who.int/medicines/
right. As the right to pain relief becomes more widely International Narcotics Control Board: www.incb.org
recognized, there may be additional opportunities for International Association for Hospice and Palliative Care: www.hospicecare.
collaboration with human rights advocates. Human com/