Transcript Perspectives of former International Pain Policy Fellows

"Perspectives of former International
Pain Policy Fellows"
Prof. Snežana Bošnjak, MD, PhD
Institute for Oncology and Radiology of Serbia (IORS)
Belgrade, Serbia
Dual nature of opioids
Essential medicines
• Moderate to severe pain
• Tx of opioid dependence
Narcotics
Potential to be abused
Controlled
Accessible
Inaccessible
Action plan: identify issues
• Oral morphine unavailable
• Neglected need for / concerns about morphine
• Lack of recognition that it is Government`s
obligation to ensure that opioids are available
and accessible for patients (dual obligation)
• Overly restrictive policies that govern the use of
opioids
Create demand for morphine
Educate that oral morphine is
Indispensable for Tx of moderate to
severe cancer pain
Appropriate for every phase of the
disease
Safe when used as recommended by
available guidelines
Convenient: variety of formulations
Create demand for morphine
Change negative attitude
Address concerns about addiction,
tolerance, side effects of morphine
Address fears that morphine implies the
final stage of the disease
Create demand for morphine
• Inform about moral obligation to prevent
people from suffering if suffering is
preventable
• Inform about right to pain relief as a human
right
• Request help from Ombudsman
Counter-Campaign: why morphine?
• Why spending money on morphine,
when the drug is not “popular” any more
• There are other, “less frightening”
alternatives to morphine
• The consumption of morphine is declining
all over the world
Textbook
Pharmacotherapy
of cancer pain
Professionals
Patient / family
Educative poster on right to pain relief
as a human right
Educative poster
on opiophobia
for patients
Working with Government
• How to balance obligation to protect against
abuse and dependence with the equally
important responsibility to ensure opioids for
pain relief and effective palliative care ?
• Inform about legal, political, public health
and moral grounds for dual obligation
• Explore possibility to participate in decisionmaking bodies
Change overly restrictive drug control
policies
• Drug regulators educated that the main (only?) goal
of drug control policies is to prevent abuse and
dependence
• No provision that recognizes that opioids are
absolutely necessary for the relief of pain & suffering
• Presentation, communication, negotiation skills
• Be prepared, work with PPSG staff, use available
resources (WHO 2011 policy guidelines)
Building support (internal)
• Interviews with practicing clinicians, pharmacists,
patients/families, caregivers
• Interviews with government drug regulators
• Professional societies (oncology, hematology, pharmacology,
pain)
• NGOs
• Pharmaceutical companies
• Influential individuals who have had recent positive
experiences w/opioid use
• Media
Building support (external)
• PPSG mentor (s)
• Other mentors: WHO, IAHPC, EAPC, OSI, HRW
• International experts / initiatives / resources
• Your colleague Fellows
• ATOME project
– Member of AAB
– Member of WHO 2011 guidelines development group
Conclusion
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Identify issues
Develop possible solutions
Seek collaboration and partnership
Build support
Capitalize on opportunity