Access to Therapeutic Opioid Medications in Europe by 2011? Fifty Years from the Single Convention on Narcotic Drugs.
Nearly 50 years after the Single Convention on Narcotic Drugs, the importance of this statement continues to hold true and is reinforced by recent UN policy declarations (ECOSOC, 2006). However there continues to be ongoing problems with access to opioid analgesics for relief of pain globally. Cherny and his colleagues from the European Association for Palliative Care (EAPC) and the European Society of Medical Oncology (ESMO) Drug Policy Initiative have documented the current status in Europe of access to opioids for pain relief in an article published in the current issue of Annals of Oncology. 1
The authors reference the extensive work of the University of Wisconsin–Madison Pain and Policy Studies Group (PPSG), a WHO Collaborating Center for Policy and Communication in Cancer Care. PPSG has described the opioid consumption trends around the world, using consumption data reported by governments to the International Narcotics Control Board (INCB). Most of the countries of the world, including those in Eastern Europe, fall well below the European and global means for opioid consumption. While there has been a significant increase in opioid consumption in Western Europe, there has been little change in the last 20 years in Eastern Europe. There is evidence that in many European countries, particularly those in Eastern Europe, patient access to the opioid medicines recommended by the WHO to relieve cancer pain is profoundly restricted by inadequate formularies, excessive regulation and the attitudes and misconceptions of both clinicians and patients.
While there are clear disparities between Eastern and Western Europe, there is also variation within the two regions. Morphine (sustained or immediate release [IR]) is available to the patient for less than 25% of the total cost in every Western European country except Iceland where patients pay 100% of the cost, perhaps a norm of their health care system. Turkey is the only Western European country without IR morphine, but does have available controlled release (CR) morphine and transdermal fentanyl, two preparations that are included in the International Association of Hospice and Palliative Care (IAHPC) list of essential drugs for palliative care. However, in that list, the IAHPC panel of experts recommended to the WHO that governments should not approve controlled release formulations of morphine, fentanyl or oxycodone, without first guaranteeing the wide availability of IR oral morphine.