Pandemic of untreated cancer pain due to overregulation of pain medicines

A groundbreaking international collaborative survey found that more than half of the world's population lives in countries where regulations that aim to stem drug misuse leave cancer patients without access to opioid medicines for managing cancer pain.

The results from the Global Opioid Policy Initiative (GOPI) project showed that more than 4 billion people live in countries where regulations leave cancer patients suffering from excruciating pain. These results were published in Annals of Oncology (2013;24[suppl11]).

National governments must take urgent action to improve access to these medicines, said the European Society for Medical Oncology (EMSO), which is the leader of a group of 22 partners that have launched the first global survey to evaluate the availability and accessibility of opioids for cancer pain.

"The GOPI study has uncovered a pandemic of over-regulation in much of the developing world that is making it catastrophically difficult to provide basic medication to relieve strong cancer pain," said lead author Nathan Cherny, MD, chair of the ESMO Palliative Care Working Group and from Shaare Zedek Medical Center, in Jerusalem, Israel. "Most of the world's population lacks the necessary access to opioids for cancer pain management and palliative care, as well as acute, postoperative, obstetric, and chronic pain."

"When one considers that effective treatments are cheap and available, untreated cancer pain and its horrendous consequences for patients and their families is a scandal of global proportions," Cherny said.

The study, conducted in Africa, Asia, Latin America, the Caribbean, and the Middle East, assessed the availability of the seven opioid medications considered by the World Health Organization Model List of Essential Medicines and the International Association for Hospice and Palliative Care to be essential for the relief of cancer pain. Those essential medications include codeine, oral oxycodone, transdermal fentanyl, immediate- and slow-release oral morphine, as well as injectable morphine, and oral methadone.

Although there are problems with the supply of these medicines in many countries, the main problem is over-regulation that makes it difficult for health care professionals to prescribe and administer them for legitimate medical use, the authors said.

"This is a tragedy born out of good intentions," said Cherny. "When opioids are over-regulated, the precautionary measures to prevent abuse and diversion are excessive and impair the ability of health care systems to relieve real suffering. The GOPI study has uncovered over-regulation in much of the developing world."

"The ongoing initiatives to reform regulations, improve accessibility, and promote the education of clinicians and consumers in the effective use of opioid medications for the relief of cancer pain will require vision, determination, and the same spirit of cooperation between organizations that made this study successful. The challenges are great, but no greater than our resolution to the task of making pain relief for cancer patients a reality irrespective of geography. Governments should look at the GOPI survey data for their country and take concrete actions to reduce the barriers," Cherny concluded.

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