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By Dr. Farzana Khan, Dhaka, Bangladesh
Founder, President & CEO, Fasiuddin Khan Research Foundation
On one of the last days of December 2018, Bangladesh accomplished a crucial step toward accessibility and availability of opioids for medical use with the enactment of its revised Narcotics Control Act.
Previously, physicians needed explicit written approval for each prescription. Now, special authorization is no longer necessary for opioid prescription. The 28-year-old law has been adjusted in line with UN conventions on drug trafficking and narcotics control, to which Bangladesh is a party.
This is the story of how the new legislation came to be.
Pain management in Bangladesh is wrong by every measure. Cancer accounts for 150,000 deaths annually, and a further 130,000 people — with moderate to severe pain — are diagnosed yearly, but opioid use is among Southeast Asia’s lowest: just 0.05 mg/capita.
On a crisp morning in August 2012, a moment of purity and beauty, this dream and sacred trust began. Rumana Dowla and I started evaluating our national policy as Pain Policy Study Group (PPSG) Bangladesh fellows with an aim to relieve the suffering and unmet pain of incurable ills.
The problem was the1990 Narcotics Control Act, Section 13, which stated that: ‘No physician shall prescribe an A‐Class or B-Class narcotic as medicine without written approval of the Director General.’1
What a great journey it’s been! What made it possible? Teamwork? Hard work? Grit? From 2012 to 2018 was a time of intense learning, acquisition of knowledge, and targeting the crucial change. To achieve our goal, we made several high-impact interventions using multi-sectoral involvement, taking every opportunity:
Having a revised law is a wonderful base for improving pain management. But we need more awareness and training for clinicians across the country. And that's where I'm going to end my remarks, because that's where we need national and international cooperation again. That is the work that stands before us.
1. Department of Narcotics Control. Narcotics Control Act, Section 13. 1990, p.