By Dr. Ebtesam Ahmed
IAHPC Board Member
As a pharmacist, I am well aware that pharmacists are an essential member of the palliative care team, especially when considering the level of reliance on medications in this setting. Palliative care patients experience increased symptom burden requiring more intensified and unique pharmacological dosing or regimens. In particular, pain is a very distressing symptom that requires specialized analgesia (e.g., controlled substances such as morphine, routes of administration, etc.).
The adequate availability and access to essential medicines is one of the four pillars of the World Health Organization’s Public Health Strategy for developing and implementing effective national palliative care programs,1 and is also a core component of strong health systems.2
Faced with the obvious, unmet need, a few years ago I decided to get more involved in advocating for the role of pharmacists globally to increase access to controlled substances for palliative care patients. My journey began in Egypt, followed by Guatemala, then Kyrgyzstan.
My main goals were to:
In 2015, 35 million people experienced serious health-related suffering from life-threatening and life-limiting conditions, or at the end of life. The majority of these people do not have access to palliative care. Over 80% live in low- and middle-income countries where access is severely lacking, and between 70% and 85% live in countries where even oral morphine — critical to palliative care, inexpensive, and effective — is largely unavailable.3
Over the years and throughout my travels, I have visited many local hospitals and cancer centers, and participated in multiple educational symposiums and workshops to advise and train pharmacists and medical staff on pain relief medications, in particular opioid analgesics (e.g., morphine).
I also emphasized the important role that pharmacists can play, considering our technical expertise, to influence the inclusion of essential medicines for palliative care, especially opioid analgesics as part of national essential medicines lists (NEMLs). In addition, as pharmacists we can provide governments with guidance on other medicines to be procured as well as the acquisition of technological equipment required.
Globally, there are currently few pharmacist champions and advocates of palliative care and pain relief, as most advocacy initiatives have focused on other professionals. However, the few pharmacists who have taken on those roles are a critical resource for influencing other pharmacists to become partners in improving access to palliative care and pain relief.
My advice to pharmacists contemplating working in palliative care is this: understand that treatment is geared not just toward dispensing medicine, but rather encompasses a whole mind-body-soul approach. It is different from general medicine in the sense that the palliative care team may not be able to treat every symptom with medicine or interventions; sometimes, nonpharmacologic solutions are necessary, or preferred. I always tell my students and residents that palliative care is a multidisciplinary approach and to respect and incorporate everyone’s ideas, from doctors and social workers to the patients themselves.
1. Stjernsward J, Foley KM, Ferris FD. The public health strategy for palliative care. J Pain Symptom Manage 2007; 33(5): 486-493.
2. World Health Organization. Monitoring the Building Blocks of Health: A handbook of indicators and their measurement strategies. 2010.
3. Knaul FM, Farmer PE, Krakauer EL, De Lima L , Bhadelia A, et al. Alleviating the Access Abyss in Palliative Care and Pain Relief – An Imperative of Universal Health Coverage: The Lancet Commission report. Lancet 2017; 391(10128): 1391-1454.
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