Problematic access to opioid medicines for pain and treatment of dependence

Problematic access to opioid medicines for pain and treatment of dependence

Willem Scholten, PharmD, MPAConsultant – Medicines and Controlled SubstancesLopik, the Netherlands

Former Team Leader, Access to Controlled

Medicines, World Health Organization

IAHPC Side-event Access to Opioid Medicines in Europe and the WorldGeneva, 19 May 2014

The global treatment crisisThe global treatment crisis

3 | IAHPC Side-event on ATOME | Geneva 19 May 2014

Inequality Inequality

93.8% of all (licit) morphine consumption by 21.8% of the world population (INCB 2010, Data for 2009)

In 2006, 4.7 billion people live in countries where medical opioid consumption is near to zero (on a total world population of 6.5 billion) (Seya et al., JPPCP, 2011.)

In 2010, 4.65 billion people live in countries where medical opioid consumption is near to zero (on a total world population of 7 billion) (Scholten W and Duthey B, J Pain and Symptom Management, 2014; 47(2):283-297)

4 | IAHPC Side-event on ATOME | Geneva 19 May 2014

From: Scholten W and Duthey B; JPS 2014.

5 | IAHPC Side-event on ATOME | Geneva 19 May 2014

From: Scholten W and Duthey B; JPS 2014

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Barriers for access to treatmentBarriers for access to treatment

Overly restrictive laws and regulations– Rules often not preventing abuse, dependence and diversion– Rules often creating a barrier for medical access

Insufficient medical education on pain

Attitudes – Excessive fear for dependence– Excessive fear for diversion– Problems related to assessment of medical needs

Economic– However, opioid analgesics are not expensive (on the international market)

Tools for improving access to controlled medicines

Tools for improving access to controlled medicines

8 | IAHPC Side-event on ATOME | Geneva 19 May 2014

WHO Policy GuidelinesWHO Policy Guidelines

15 languages In print: English, French and Spanish

On-line: free of charge (including languages of most ATOME countries)

http://www.who.int/medicines/areas/quality_safety/guide_nocp_sanend/en/index.html

Ensuring Balance in National Policies on Controlled Substances, Guidance for accessibility and availability of controlled medicines (Geneva 2011)

9 | IAHPC Side-event on ATOME | Geneva 19 May 2014

Based on Principle of BalanceBased on Principle of Balance

Obligation of governments to establish a system of drug control that

– ensures the adequate availability of controlled substances for medical and scientific purposes

– while simultaneously preventing abuse, diversion and trafficking

21 Guidelines

Provides many examples

Country Check List

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Persisting Pain in Children PackagePersisting Pain in Children Package

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Treatment of Opioid Dependence Treatment of Opioid Dependence

Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence (WHO, 2009)

12 | IAHPC Side-event on ATOME | Geneva 19 May 2014

Opioid Price WatchOpioid Price Watch

Developed by the International Association for Hospice and Palliative Care (IAHPC)

Tool for comparing prices of opioid analgesics by countries

Launched this week

http://hospicecare.com/about-iahpc/projects/opioid-price-watch/