Left to right: Eugenia Larjow, Lukas Radbruch and Lisa Linge-Dahl
Lukas Radbruch, Eugenia Larjow and Lisa Linge-Dahl for the ATOME Consortium
The Access to Opioid Medication in Europe (ATOME) project, initiated by the Access to Controlled Medications Programme of the World Health Organization (WHO) and funded under the 7th Framework Programme of the European Community in 2009, came to an end in November 2014 after five years of project work. The project investigated why opioid medicines for moderate to severe pain and for the treatment of opioid dependence are not used adequately in 12 European countries, and developed tailor-made solutions for improved access to opioid medicines in these countries.
A central feature of the ATOME work plan was close collaboration of pain and palliative care experts, harm reduction experts and policy makers, together with national counterparts in each of the target countries. Key stakeholders were invited to become a member of the national country teams that comprised government officers, legal experts, palliative care and harm reduction specialists, and patient representatives. Collaboration with the national counterparts culminated in a series of ATOME conferences in the 12 countries. Project activities were based on the WHO policy guidelines, Ensuring Balance in National Policies on Controlled Substances, Guidance for Availability and Accessibility for Controlled Medicines, which were revised as part of ATOME using an expert consensus process. Building on this, ATOME activities focused on legal analysis and on analysis of national policies. This analysis, as well as self-assessment using the checklist of the Balance guideline, was an important tool in analysing national problems and developing strategic action plans in the national conferences.
ATOME has produced some remarkable changes in the participating countries during the lifetime of the project.There are examples of changes that may be directly attributable to the ATOME project. In Estonia, validity of prescriptions for controlled medicines has been extended from 14 to 30 days, and digital prescription was implemented in October 2012. Similarly, Turkey started to implement an e-prescription system in July 2012. In Greece, legislation on controlled medicines was changed in March 2013, changing the designation from ‘narcotics law’ to ‘law on substances causing addiction’, introducing the principle of balance by mentioning patients with chronic illnesses as potential users of controlled substances, and an option for pharmacists to fill a prescription with a higher amount in emergency cases. In addition, a palliative care specialist was included in the Committee on Narcotics in the Ministry of Health. In Lithuania, the Department of Pharmacy in the Ministry of Health has amended regulations on opioid agonist therapy (OAT), allowing an increase in the amount and length of time that opioid medications may be stored in healthcare facilities, from seven to 60 days.
While some changes may have been triggered equally by recent palliative care developments, feedback from country teams suggests that ATOME activities have contributed significantly to these developments. Even if not related directly to changes in legislation, ATOME activities resulted in more subtle changes, bringing together stakeholders from government, palliative care and pain management, as well as harm reduction. This collaboration and networking have resulted in a change of atmosphere, and will produce more changes in legislation in the medium and long-term development that will overcome regulatory and legislative barriers.
Additional activities are planned to inform about the results of ATOME, including a side event at the 58th Session of the Commission of Narcotic Drugs (CND) on 10 March 2015 in Vienna, Austria. This event, on the ATOME methodology and results as an example for other regions, is sponsored by the governments of Germany and Lithuania and co-sponsored by the International Association for Hospice and Palliative Care (IAHPC) and the Union for International Cancer Control (UICC).
The final report and the annex with the country reports can be downloaded from the ATOME website or as Kindle edition copies. In addition, scientific evaluation on barriers and challenges relevant for access to opioid medicines is being prepared for publication.
Several of the countries participating in the ATOME project are already revising legislation and policies, and implementing recommendations for improvement. As a result, several changes in legislation and policy have already come into force, lifting potential barriers to access to opioids. Based on the analyses and outcomes of the ATOME project general recommendations can be derived for all countries aiming to achieve, and to ensure, a balanced approach in national policies on controlled substances.
We would like to thank everybody in the consortium and in the country teams who worked with us so diligently over the past five years. A list of everyone involved is available on the ATOME website. Thank you for dedicating so much of your time and energy to improving access to opioid medicines for all those who need them!
ATOME Recommendations
- Implement the WHO policy guidelines Ensuring Balance in National Policies on Controlled Substances, Guidance for Availability and Accessibility for Controlled Medicines;
- Identify potential legal and regulatory barriers to access to opioid medicines and working on changes with the aim to improve accessibility, availability and affordability.
- Ensure non-stigmatizing language in legal documents and language in official documents (e.g. by using the term ‘Narcotic drug’ only when referring to substances controlled under the Single Convention);
- Establish regular exchange opportunities (communication networks) between legal and governmental authorities, healthcare professionals and patients/families in order to raise awareness for practical impact and requirements of legal and policy decisions (target-performance comparison) regarding opioid availability and accessibility;
- Provide and support the implementation and development of national databases (including data on long-term outcomes and national fear of opioids) suitable for scientific research, evaluation of models of treatment with opioids and for monitoring the national demand on Essential Medicines;
- Ensure that treatment with opioids (knowledge, skills, attitudes) will be included in undergraduate and postgraduate education for relevant healthcare professionals (primarily physicians, nurses, pharmacists);
- Raise awareness and sensitisation for treatment with opioids among practicing healthcare professionals (e.g. via Continuing Medical Education, publication series on the rational use of opioids in highly-accessed national medical journals, a survey on knowledge and attitudes regarding opioid medicines);
- Raise awareness in the general public, e.g. via media campaigns or information, brochures for patients and relatives.
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