E-DRUG: Consultation on WHO road map on access to medicines and vaccines 2019-2023 (2)
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I just had a quick look at the WHO zero draft roadmap for access to
medicines and vaccines 2019-2023. What strikes me is that there is not
any attention for access to medicines controlled under the
international drug control conventions, including pain medicines.
The access situation for controlled pain medicines (opioid analgesics)
is much harsher than it is for other medicines. According to WHO's own
figures 5.5 billion people did not have access to adequate pain
management in 2006, and as a consequence:
"each year tens of millions of patients are suffering without adequate
treatment [because of lack of access to controlled medcines, including
other than pain medicines - WS]:
* 1 million end-stage HIV/AIDS patients
* 5.5 million terminal cancer patients
* 0.8 million patients suffering injuries, caused by
accidents and violence
* Patients with chronic illnesses
* Patients recovering from surgery
* Women in labour (110 million births each year)
* Paediatric patients" (quoted from a WHO Briefing
note)
As I found when working on opioid consumption statistics for my PhD
thesis, this sad situation did not change from 2000 to 2015 and the
percentage of people not having access remained stable at around 70% of
the world population, but with increasing inequality between developing
and industrialized countries.
I also concluded that access to availability of opioid analgesics is
about one quarter to half that of non-opioid medicines.
In 2005, WHO established the Access to Controlled Medication Programme
and under this programme it conducted the ATOME Project (Access to
Opioid Medications in Europe) together with a number of other
organizations from 2009 - 2014.
Unfortunately, all WHO activity around improving access to controlled
medication has come to a standstill after 2014, and except for its
paediatric chronic pain guidelines, WHO did not ever publish any
evidence-based pain treatment guidelines.
In order to overcome this situation, at least Section 6, "Regulatory
systems to ensure quality , safety and efficacy of medicines and
vaccines", should cover ensuring access to medicines. Its title should
be changed into "Regulatory systems to ensure accessibility, quality ,
safety and efficacy of medicines and vaccines" and the content should
indicate which regulatory steps to take to achieve better access to
controlled medicines.
What are these steps can be found in the Framework of the Access to
Controlled Medications Programme and multiple publications resulting
form the ATOME Project. No need to find out everything again.
But moreover, the ATOME project above concluded that apart from
regulatory barriers, medical education on pain management falls short
in many countries and doctors hardly know how to use opioid analgesics,
while also hand and text books do not properly describe the usage of
opioid analgesics. This should be addressed as well in this roadmap.
What most people in the world expect from a physician, aside from being
healed from their disease, is that they do not have to suffer. It is
the latter expectation that unfortunately is not met for a large a
majority of the world population. Therefore, this should be given a
high priority in any WHO strategy for improving access to medicines and
vaccines.
Willem Scholten
Willem Scholten PharmD MPA
Consultant - Medicines and Controlled Substances
Wielsekade 64
3411 AD Lopik, the Netherlands
wk.scholten@xs4all.nl