Ensuring Patient Access to Essential Medicines While Minimizing Harmful Use: A Revised Who Tool to Improve National Drug Control Policy
In 2011, the World Health Organization (WHO) published a series of 21 guidelines to assist governments in improving their national drug control laws, regulations, and administrative procedures to promote the availability of controlled medicines for pain relief and for a variety of acute and chronic diseases and conditions. These guidelines ultimately are designed to encourage the development of policies designed to fulfill a country’s dual obligation concerning these medicines: to prevent their abuse, diversion and trafficking while ensuring access for medical and scientific purposes. This article summarizes each guideline and outlines the constituents who can actively participate in making controlled medicines available to the patients who need them. It is hoped that representatives of governments and medical institutions, as well as health care professionals, will commonly and effectively use the revised WHO guidelines as a policy change tool.
Global health is a changing field, transitioning from a historic focus on infectious diseases to noncommunicable diseases that now account for 60% of the deaths worldwide (1). Despite the availability of medical knowledge and both nonpharmacologic and pharmacological treatment modalities, inadequate management of pain, especially pain due to cancer, continues to be a serious health problem in the world. The incidence of cancer is greatest in developed countries, but will shift to developing countries where most patients do not receive the diagnosis of cancer until the disease is already in the late stage and when pain is prevalent (2, 3). In this scenario, the appropriate medical and humane response is to provide pain relief and palliative care. Educating health care practitioners about these clinical issues can help improve the application of effective treatments, but the inadequate availability and accessibility of opioid analgesics also must be successfully remedied to be able to provide sufficient pain relief. Opioids also can be effective modalities for managing pain other than from cancer, both acute and chronic, as well as for the treatment of other conditions unrelated to pain.
Opioid analgesics are indispensable for the management of pain, and there has been a notable cumulative increase in their consumption in recent years. This increase in medical use, however, has occurred predominantly in developed countries, with approximately 80% of the global population still lacking access to morphine for treating pain (4). When pain is moderate to severe, there can be few adequate substitutes for opioids in the class of morphine, which also includes fentanyl, hydromorphone, and oxycodone (5).