Improving Availability of and Access to Opioids in Columbia: Description and Preliminary Results of an Action Plan for the Country
The World Health Organization (WHO) and other organizations have designated morphine and codeine as essential analgesics for the treatment of pain;1 their safety and efficacy have been proven in many studies. Morphine consumption has been used for several years as one general indicator of the availability of pain treatment in countries of the world. Unfortunately, the use of morphine in Latin America accounts for less than 3% of the amount used at a global level according to the International Narcotics Control Board (INCB).2 Colombia reports a per capita consumption (1.09 mg/ capita) significantly lower than the global average (5.98 mg/capita).3
There are several initiatives to improve availability of opioids in the world many of them under the leadership and guidance of the Pain & Policy Studies Group (PPSG), a WHO Collaborating Center for Policy and Communications in Cancer Care. Among these are specialized opioid availability workshops between health care providers, regulators, and other stakeholders using the WHO Guidelines for Achieving Balance in National Opioids Control Policy.4,5 The importance of involving leadership from governmental entities, nongovernmental organizations, and between the stakeholders and health professionals has been emphasized to encourage communication and collaboration and to identify solutions to the problems.6
Recent experiences following this model have been described in Romania, India, Uganda, Italy, and Vietnam, with significant improvements in policies.7e12 Availability of opioids in Latin America has also been reported in several meetings and publications. Restrictive laws and regulations, exaggerated fears of addiction, the lack of education among health care professionals, and the lack of political support have been consistently identified as the most significant barriers in the availability of opioids in the region.13e15 Resolution 5261 from the Colombian Ministry of Health, which regulates the access to health services in Colombia, fails to recognize pain treatment and palliative care as priorities.16