Throughout the year, IAHPC board members contribute a range of opinion pieces and other thought-provoking articles to the IAHPC Newsletter. This month, it is the turn of our board member Professor Rosa Buitrago from the Republic of Panama.
As Professor of Pharmacology and Pharmaceutical Care in Cancer Pain Management in the School of Pharmacy, University of Panama, Rosa has trained hundreds of healthcare providers in the field of pharmacology and pharmacotherapy of pain management and palliative care. Her other areas of expertise include policy-making to improve access to opioids and pain management in Latin America, and curriculum planning in pharmacology, pharmacotherapy of pain, palliative care and quality of medicine.
Patients suffering from pain are everywhere. Day-by-day, millions of people worldwide who suffer from pain are inadequately treated. To relieve moderate to severe pain that accompanies chronic diseases, there is a clear choice: the group of medicines classified as morphine-like opioids. Several forces converge around this issue preventing these patients from having access to these medicines. Often we reflect on each of these forces in our classes.
On the one hand, there are strict regulations governing the prescription, dispensation and use of opioids. Governments usually generate these laws giving more emphasis to measures of control than to access measures. It is not uncommon to find laws and decrees that urge health professionals not to prescribe or dispense these valuable medicines because of a genuine fear of the severe penalties associated with these practices, ranging from heavy fines to the possible loss of professional qualifications. Often, these rules go far beyond the issues raised by the Convention of 1961, which neither require a special prescription nor set a time or dose limit by which the physician can prescribe.
On the other hand, there are local and international groups that are working to increase access and availability of opioids while respecting control measures, which undoubtedly are necessary. Elsewhere, we find barriers associated with the inappropriate use of terminology that instead of decreasing seems to be growing. Regularly, publications in this field come with the dreaded words: Drugs, Addiction, Addict. The use of these words is an invisible but insuperable barrier to pain relief.
The lack of curriculums aimed to develop skills in pain management, and how to calculate the opioid dose, is a barrier that seems impossible to overcome.
With growing concern, we note the regular flow of publications indicating that the inappropriate use of opioids is linked to abuse, misuse and even deaths. Every time I read one of those articles I wonder: Shall we start to publish the results of our research promoting the safe and proper use of these medications? There are already guidelines for treating patients at risk of developing dependency syndrome. Those pharmacists trained in pain management can guide and monitor these patients. There is a statement from the American Society of Health-System Pharmacists (ASHP) on the pharmacist’s role in hospice and palliative care. We need to apply it!
Based on these issues, I continually call upon my students and colleagues to reflect on this: Regardless of the nature of these barriers, each of us should implement – as soon as possible – the necessary changes in our working practice – because pain is still there marking the lives of millions of people.
1. Am J Health Syst Pharm. 2002 Sep 15; 59 (18): 1770-3. ASHP statement on the pharmacist's role in hospice and palliative care.
2. Juba K M. J Pharm Pract. 2012 Oct; 25 (5): 517-20: Pharmacist credentialing in pain management.