Improving the Availability and Accessibility of Opioids for the Treatment of Pain: The International Pain Policy Fellowship
Opioid analgesics (opioids) are indispensable medicines for the treatment of moderate to severe pain. The use of chronic opioid therapy to treat cancer pain is well established [1-3] and it is also considered appropriate for treating chronic non-cancer pain in carefully selected patients [4] and pain in AIDS [5]. The availability of opioids is a critical part of effective supportive and palliative care [6]. At the same time, opioids have the potential to be abused and are legally classified as controlled substances (“narcotics”) by the Single Convention on Narcotic Drugs, 1961 (Single Convention) [7], the international treaty governing opioids, as well as by corresponding national drug control laws. The Single Convention stipulates a dual obligation that governments must control narcotic drugs to prevent their diversion and abuse while ensuring their adequate availability for medical and scientific purposes. This is known as the “Principle of Balance,” the prevailing international standard in formulating opioid control policy [8]. The challenge for governments is therefore to balance the obligation to prevent diversion, trafficking, and abuse of opioids as controlled substances with the equally important obligation to ensure their availability and accessibility for the relief of pain and suffering. This public health challenge has grown in prominence over the past 15 years in some high-income countries as there has been an increase in the abuse and diversion of strong opioids that has correlated with their increased availability for medical and scientific purposes. The dual nature of opioids, that they are simultaneously essential in medical practice and harmful when abused, underlies and contributes to the problem of opioid accessibility. Opioid control measures tend to focus on the harmful aspect of opioids and are often inappropriately restrictive, rendering opioids inaccessible for patients who need them for medical purposes. It is estimated that in over 80% of the world population, pain is inadequately treated because people lack access to opioids, causing needless suffering of patients and their families [9].