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People with medical needs are being “left in pain”, a new report reveals
The World Health Organization (WHO) published a new report on access to morphine for medical use, which describes how the global distribution of morphine, as a vital pain reliever, is uneven and does not meet medical needs. The report, entitled “Left in Pain”, highlights the problems in accessing this essential medicine and offers measures to improve safe access through balanced policies.
Despite morphine being an effective and relatively inexpensive drug to relieve severe pain, listed since 1977 in the first edition of the World Health Organization’s Model List of Essential Medicines, the difference in approach between countries is large. It’s there Difference from 5 to 63 times in estimated mean morphine consumption between high-income and low-income countries.
Consumption patterns vary significantly among countries of similar wealth; does not meet medical needs, as indicated by the estimated number of days people suffer pain or severe shortness of breath for people with a terminal illness.
These data echo those from Commission for lancets 2018 who described the lack of access to pain relievers as ‘one of the most hideous, hidden inequalities in global health’ with the richest 10% of countries owning 90% of the morphine-equivalent opioids distributed.
“Leaving people in pain when effective drugs are available to control pain, especially in the context of end-of-life care, should be a cause of serious concern for policymakers,” says Dr Yukiko Nakatani, WHO’s Assistant Director-General for Medicines and Health Products . “We must urgently advocate for safe and timely access to morphine for those in medical need through balanced policies, everywhere.”
Reasons for the disparity
Access to morphine for medical use is affected by many interrelated factors including factors related to good governance, reliable/effective procurement and supply processes, availability of resources and capacity building activities, together with barriers related to overly restrictive legislation and policies, inadequate service delivery, and misinformed attitudes and perceptions.
Given different country contexts, factors, barriers and priorities for action differ; the stakeholder survey presented in this report, with respondents from 105 WHO Member States, confirms this variation. For example, the irregular supply of morphine and other strong opioids in health facilities due to limited funding is commonly cited as a barrier in low- and middle-income countries compared to high-income countries. More than a third of respondents across all regions also noted barriers arising from legislative and regulatory factors, while recognizing the importance of a legislative and regulatory framework to achieve safe access. Unreasonably restrictive requirements could hinder access for patients by disrupting the flow of supplies or making it difficult for healthcare professionals to prescribe and dispense drugs.
It is important to note that concerns about the possible adverse effects of opioids are valid, such as their potential to lead to opioid use disorders. For this reason, a certain amount of caution regarding the potential harms of opioid use (eg, use for chronic non-cancer pain) is important for public health if their use is well-informed and proportionate to the risks. Such concerns should not diminish the benefits of using opioids when clinically indicated and safely used by trained professionals.
Possibilities for action
The report presents a complementary set of areas for action aimed at improving safe access to morphine. This includes the implementation of small regional or national programs to improve access to morphine for medical use with a package of essential services and products for palliative care that is formulated according to the model of the WHO Essential Medicines List and the WHO Care Palliative Core Package. They also include improving governance, streamlining procurement and supply processes to address any inefficiencies, improving resources such as stable funding, improving the skill set of the health workforce and raising awareness of the benefits and potential harms of opioid use. The success of these actions will depend on cooperation and collaboration among all stakeholders at national, regional and global levels.
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Sources 2/ https://www.who.int/news/item/16-06-2023-people-with-medical-needs-are–left-behind-in-pain–reveals-new-report The mention sources can contact us to remove/changing this article |
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