Transcript Improving Morphine Availability in Resource Limited Settings

Improving Morphine
Availability in
Resource Limited
Settings
Uganda’s Experience
Uganda at a Glance…
 A former British Colony
 Independence – October 9th 1962
3
 1971-79 – dictatorial regime of Idi AMIN
 1980-1985 – guerrilla war & human rights
abuses; many lives were lost.
 Relative stability and economic growth since
1986
 High burden of life-threatening illnesses –
HIV and Cancer
Uncontrolled pain
The Beginning
 Very high disease burden associated with
severe pain
 Absence of opioids to control pain
 Worked closely with MoH and Drug
Regulatory Authority
 Many barriers identified
Barriers to opioids availability
 Severe Opiophobia and Morphinephobia;
 Inadequate knowledge about morphine;
 Overly restrictive laws governing use of
narcotics;
 Anti-Narcotic Enforcement fear of
diversion;
 Problems of distribution of Opioids to
remote rural areas;
 Shortage of prescribers and dispensers
due to a poor doctor to population ratio;
Finding solutions to the
barriers
 Education, Sensitization, Advocacy
 Facilitating distribution to remote rural
areas;
 Revisiting and amending restrictive and
outmoded laws on narcotics
 Expanding the prescribers of opioids
 Demystifying concerns about Addiction
Guideline on Handling
Opioids
 Proper Guidelines – by
MoH
on how to handle Narcotics
including morphine for medical
use while preventing illicit use
– the fundamental principle of
Balance
Dispensing Morphine as per
Guidelines
Measuring and Labeling
A Morphine Prescription
Dispensing of Morphine
 Details are recorded in specific book and
signed for by person collecting the medicine
 Detailed instructions for taking the drug are
given
Signing for Medicine
Clear Instructions on Usage
Clear Instructions

This medicine is not to be shared

Patient should take it as instructed and you can
call this number in case of questions

Return all unused medicines to Hospice
pharmacy

For patients from upcountry return to clinic with
remaining medicines (if at all)

When a patient dies remaining medicines should
be brought back and if not possible to be poured
in a pit latrine
Finding solutions to barriers
through clinical education

Palliative care in medical
training curriculum

Encouraging use of affordable
but effective oral morphine
solution

Educating the public about
opioids

Doctors and students on a Ward Round
Learn about use of morphine
The media – TV and Radio
Improving accessibility through
task shifting – nurse prescribing
2004 – Government amended the law on
narcotics to authorize specially trained
nurses and clinical officers with a certificate
to prescribe and dispense oral morphine.
MINISTRY OF HEALTH
STATUTORY INSTRUMENTS
SUPPLEMENT No. 13
23rd April, 2004
STATUTORY INSTRUMENTS SUPPLEMENT
to The Uganda Gazette No. 18 Volume XCVII dated 23rdApril, 2004
Printed by UPPC, Entebbe, by Order of the Government.
STATUTORY INSTRUMENTS 2004 No. 24.
Authority
to prescribe
Restrictions
on prescribing
Narcotic
Analgesic Drugs
to be prescribed
Requirements for
prescribing
PART II - PRESCRIPTION AND SUPPLY OF CERTAIN NARCOTIC ANALGESIC
DRUGS
4. Subject to regulations 5,6 and 7 a Clinical Officer or a Nurse with a certificate in specialist
palliative care shall be authorised to prescribe and supply the narcotic analgesic Drugs
specified in the Schedule.
5. A Clinical Officer or a Nurse authorised to prescribe drugs under regulation 4 may only
prescribe drugs for the management of pain and as part of the palliative care of patients
suffering from severe pain and similar symptoms.
6. The narcotic analgesic drugs to be prescribed under regulation 4 shall be only those
products and in the form described in the Schedule.
7. The requirements for prescribing narcotic analgesic drugs referred to in regulation 6 shall
be those in paragraph 3 of the Ministry of Health Guidelines for Handling of Class A Drugs,
March 2001 or any revisions to those guidelines.
SCHEDULE
NARCOTIC ANALGESICS WHICH MAY BE PRESCRIBED AND SUPPLIED BY
CLINICAL OFFICERS AND NURSES
1. Morphine oral solution 1 mg/1mL (or 5 mg/5mL)
2. Morphine oral solution 50mg/5mL
3. Morphine tablets SR 10 mg
4. Morphine tablets SR 30 mg
5. Morphine tablets SR 60 mg
BRIG JIM MUHWEZI,
Minister of Health.
Successes
 Health Sector Strategic Plan – PC included
in the Basic Package under MOH Essential
Clinical Care;
 Government committed to availability of
Opioids to all patients who need it since
2003;
 Government distribution system to rural
areas – NMS
 Circulars from MOH to all directors of health
institutions to ensure availability of opioids
for medical use at all times
Challenges
 PC still looks strange to some clinicians and
policy makers
 Slow policy changes and implementation
 Resistance from among health workers
 Capacity to reconstitute Oral Morphine
Solution is still limited
 Getting reliable suppliers of Oral Morphine
 Difficulty accessing patients in remotely
placed areas.
What is making it possible?

Working closely with government and partners in
development

Creating awareness within the Drug Enforcement
Commission about the medical and scientific
roles of opioids

Involving the nursing profession – the backbone
of palliative care

Continued education:



Health workers
Allied health workers
Patients, family and general public