Palliative care and access to medications for pain treatment

The World Health Organization (WHO) recommends that controlled, essential medications are absolutely necessary for treatment for moderate to severe pain for people with cancer. Yet millions of people worldwide with life-limiting conditions are living and dying in pain and distress due to the lack of availability and accessibility of these medications. WHO estimates that 5.5 million people with cancer suffer from moderate to severe pain . The disparity in the availability and consumption of treatment for pain is stark with an estimated 80% of the world’s population living in countries with low or no access to pain treatment for moderate to severe pain. More than 99% of untreated deaths in pain from cancer and HIV are in low- and middle-income countries. Access to appropriate pain treatment for children is a particularly challenging issue.

At the global level, numerous policies, resolutions and guidelines clearly outline the need for access to medications for pain treatment. The WHO Essential Medicines List 21 includes opioid analgesics. However, at the national level, policy developmentis challenging. Many countries do not have cancer control policies. Indeed in 2006, only two countries in Africa had a cancer control programme. It is thought that 38 countries worldwide have either a stand-alone national hospice and palliative care policy, or palliative care is integrated within the existing national health, HIV or cancer policy. While many countries have opioids on their essential drugs list, this does not seem to be reflected in the consumption figures of opioid analgesics as reported by the International Narcotics Control Board. The need for palliative care policies and integration of palliative care into existing HIV, health and cancer policies is fundamental to the development of palliative care services and the availability of analgesics.

Policy and guidelines The World Health Organization has republished and reviewed the “Ensuring balance in national policies on controlled substances” which provides clear guidelines to national governments on how to ensure the availability and accessibility of controlled medicines. These guidelines need to be utilized by national governments and acted upon. The World Health Organization also released guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. The International Children’s Palliative Care Network (ICPCN) have also developed an e-learning training module linked to these guidelines. In 2012, the Worldwide Palliative Care Alliance, in collaboration with the World Health Organization, published a report on the global mapping of palliative care at the end of life. This gives a comprehensive picture of the need and the availability of palliative care.