Morphine Consumed Per Capita by Country (2001)

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Palliative Care for HIV/AIDS Overview of Opioid
Availability
Kiev, Ukraine 28 February, 2004
David E. Joranson Pain Policy Studies
Group World Health Organization Collaborating
Center www.medsch.wisc.edu/painpolicy
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Main points about opioids (1)

• Essential for relief of moderate to severe pain
• Not adequately available in most of the world
• Exaggerated concerns about addiction
• Strictly controlled to prevent abuse
• Strict controls are a barrier to availability

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Main points about opioids (2)

• Regulatory barriers include
• Drugs not available
• Burdensome prescription requirements
• Restrictions on dose, quantity
• Complex licensing requirements
• Penalties for mistakes

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Main points about opioids (3)

• Governments are obligated by treaties to ensure
  availability
• Governments have been requested to evaluate
  policies
• WHO developed guidelines to evaluate national
  opioids control policies
• National consumption statistics are a general
  indicator of progress

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Opioid consumption in Europe

• Governments report consumption statistics
• International Narcotics Control Board
• Medical use of principal opioids
• Quantities distributed to the retail level
• Outcomes monitoring
• www.medsch.wisc.edu/painpolicy

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Consumption of Morphine in Europe mg/capita, 2001
Mg/capita
Global mean5.4 mg/capita
Ukraine1.3 mg/capita
Source International Narcotics Control Board
United Nations Demographic Yearbook By Pain
Policy Studies Group, University of Wisconsin/WHO
Collaborating Center, 2004
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Total Consumption of Morphine - USSR
(historical) -1964 - 1991
Kilograms
Source International Narcotics Control Board
United Nations Demographic Yearbook, 2000 By
Pain Policy Studies Group, University of
Wisconsin/WHO Collaborating Center, 2004
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Total Consumption of Morphine - Russian
Federation -1992 - 2001
Kilograms
?
?
?
? No report
Source International Narcotics Control Board
United Nations Demographic Yearbook, 2000 By
Pain Policy Studies Group, University of
Wisconsin/WHO Collaborating Center, 2004
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Total Consumption of Morphine - Republic of
Moldova -1992 - 2001
Kilograms
?
?
?
?
?
?
? No report
Source International Narcotics Control Board
United Nations Demographic Yearbook, 2000 By
Pain Policy Studies Group, University of
Wisconsin/WHO Collaborating Center, 2004
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Total Consumption of Morphine - Ukraine -1992 -
2001
Kilograms
?
?
?
?
?
?
? No report
Source International Narcotics Control Board
United Nations Demographic Yearbook, 2000 By
Pain Policy Studies Group, University of
Wisconsin/WHO Collaborating Center, 2004
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In many countries, consumption of opioid
analgesics remains extremely low in comparison
to medical need, and many national governments
have yet to address this important deficit.

• International Narcotics Control Board, 1996

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Recommendation to GovernmentsReduce
regulatory barriers to availability of opioid
analgesics

• International Narcotics Control Board
• (1989, 1996)
• World Health Organization
• (1990, 1996, 1998, 2000)
• Council of Europe
• (2003)

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Council of Europe Recommendation 24
Organisation of Palliative Care 12 November
2003

• Palliative care needs further development
• Insufficient availability of opioids
• Governments should identify legal barriers
• Legislation should make opioids available
• Fear of abuse should not hinder access

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www.medsch.wisc.edu/painpolicy
WHO/EDM/QSM/2000.4 ENGLISH ONLY DISTRIBUTION
GENERAL 
NARCOTIC PSYCHOTROPIC DRUGS  ACHIEVING BALANCE
IN NATIONAL OPIOIDS CONTROL POLICY    GUIDELINES
FOR ASSESSMENT
World Health Organization
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Achieving Balance in National Opioids Control
PolicyWHO, 2000

1. 1. Evaluate national narcotics control policy
2. 2. Report consumption, estimate needs
3. 3. Administer an effective distribution system to
   the patient

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The goal balanced national policy

• Government narcotics policy and administrators
  should ensure availability of opioids for medical
  use
• Efforts to prevent drug abuse must not interfere
  with availability of opioid analgesics to the
  patient

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Government actions to reduce regulatory barriers

• France Poland
• Germany Spain
• Italy

• Increased Rx amount
• Reduced Rx requirements
• Simplified Rx form
• Reduced reports to government
• Reduced penalties
• Reduced costs

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Take-home messages

• Regulatory barriers can be removed
• Cooperation with government is essential
• Training of health professionals is essential
• Opioids can be made safely available
• Pain relief with limited resources is possible
• Patient access is the bottom line

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Thank you!

• Pain Policy Studies Group
• WHO Collaborating Center
• Univ. of Wisconsin Comprehensive Cancer Center
• Madison, Wisconsin USA
• www.medsch.wisc.edu/painpolicy