Ahead of World Hospice and Palliative Care Day on 8 October, Dr. Liz Gwyther, Chair of the Worldwide Hospice Palliative Care Alliance and CEO of the Hospice Palliative Care Association of South Africa, explains why we need to spread the word and support the event.
Seventy-five percent of the world’s population does not have adequate access to controlled medications for pain relief. Australia, Canada, New Zealand, the United States, and several European countries account for more than 90 percent of the global consumption of opioid analgesics. In developing countries, opioid medications are principally used following surgery for post-operation pain control.
People with life-threatening conditions are living and dying in pain even though there are medicines available and healthcare workers with the knowledge of interventions that can control pain. The lack of appropriate pain management should be seen and addressed as a public health emergency.
People should not be living and dying in pain!
Restrictive regulations
In some countries, archaic and restrictive legislation affects access to opioid medication. The recent UNGASS meeting (UN General Assembly Special Sessions) called for a balance between control of drug abuse and adequate access to essential pain medication.
There is action to improve access to opioid medication worldwide, but the emerging concerns about over-prescribing of opioid medication in the USA have led to additional restrictions to access to opioids.
Opiophobia
There is a continuing need for adequate medical and nurse training in pain management. Worldwide, there is still a lack of this training, and a misconception of opioids as dangerous medicines (opiophobia) results in inadequate assessment and management of pain.
Both medical personnel and people experiencing life-threatening illness have come to expect pain as part of the disease process, so there is an acceptance of inadequate pain management.
Economic barriers
Morphine is inexpensive to produce yet expensive to bring to market in many places with unduly restrictive regulations. As a result, the pharmaceutical industry has little or no incentive to produce and market oral morphine for pain management.
Actions to address the public health emergency of pain include training of healthcare workers and – especially in the developing world – training and licensing of nurses to prescribe controlled medication.
The public, including patients and families, need clear, accurate information about the benefits of palliative care and pain medication.
Countries need to review and revise their Essential Medicines Lists and to ensure that legislation does not restrict access to controlled medicines for pain relief.
Pain is debilitating and affects every aspect of a person’s life. In 2013, the United Nations Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, presented a report to the United Nations on torture in health care, identifying denial of pain relief as being tantamount to torture.
We need to spread the word that: ‘Living and dying in pain doesn’t have to happen’, that palliative care supports people to live as pain free and as actively as possible.
Countries worldwide are challenged to implement the World Health Assembly resolution: ‘Strengthening of palliative care as a component of comprehensive care throughout the life course’.
This resolution sets down the recommendations for better access to pain medicines and appropriate care for people with life-threatening and life-limiting illnesses to address the imperative that: “palliative care is an ethical responsibility of health systems, and that it is the ethical duty of health care professionals to alleviate pain and suffering.”
You can find out more about World Hospice and Palliative Care Day, download materials and register your World Day event.
To celebrate World Hospice and Palliative Care Day on 8 October, the Asia Pacific Hospice Network (APHN) is launching an advocacy film. The film, entitled ‘Life after Death’, aims to support advocacy efforts and to create greater public awareness of hospice and palliative care. The APHN hopes you will consider screening this film as part of your World Day activities.
The 26-minute documentary was filmed on location in Bangladesh, Myanmar and Sri Lanka earlier this year as part of the Lien Collaborative for Palliative Care project.
The documentary is freely available online. The website also contains two five-minute films aimed at policymakers relating to opioid availability, as well as photographs and infographics. Subtitles will be available in Burmese, Bengali, Singhalese and Tamil. The APHN will work with you to create subtitles in more languages.
To register your interest, please email the APHN Secretariat quickly.
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