E-DRUG: New Report Exposes Global Lack of Access to Essential Analgesics
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FROM WORLD HOSPICE AND PALLIATIVE CARE DAY,
HOSPICE HOUSE,
34-44 BRITANNIA ST,
LONDON WC1X 9JG, UK
Embargoed until 28th September 2007
New Report Exposes Wide-Scale Lack of Access to Essential Analgesics
Access to Pain Relief - An Essential Human Right is a new report published today [28th September] by UK national hospice charity Help the Hospices, with an introduction by the World Health Organization. It investigates the widespread lack of access to pain relief available to terminally ill people in many parts of the world, highlighting the fact that cost is not usually the main barrier.
The report, which is published to mark World Hospice and Palliative Care Day on 6th October (www.worldday.org), states that around 80% of the world's cancer sufferers have no access to analgesics and that while the majority of pains can be controlled, an estimated 7% of all people in the world suffer cancer pain that could be relieved but is not. It also looks at incidences of pain and the availability of analgesics with reference to other advanced and terminal diseases including AIDS*, heart disease, chronic obstructive pulmonary disease and renal disease. It points out that the majority of people denied access to pain relief are in developing countries while pain incidence is often higher in developing countries.
The report showcases the findings of a new survey conducted among 69 hospice and palliative care services in Asia, Africa and Latin America, as well as drawing together disparate sources of information about the state of access to pain relief globally.
The survey asked healthcare workers to:
. Score their patients' access to analgesics on the WHO Essential Medicines List or the International Association of Hospice and Palliative Care (IAHPC) list of essential medicines for palliative care (using a Likert-type scale).
. Detail reasons why they thought patients were not able to access oral morphine.
Survey findings include:
. 25% of palliative care providers in Asia, 35% in Latin America, and 39% in Africa cannot always access a strong opioid.
. For 41% of palliative care providers in Africa and 39% in Latin America oral morphine is not always available and for 21% and 18% respectively oral morphine is never available
. Only 55% of healthcare workers providing palliative care in Asia, Africa and Latin America have a weak opioid 'always available'. 22% have access only 'occasionally' or 'never'.
. In Asia, Africa and Latin America many were unable to 'always access' any of the adjuvant analgesics useful for neuropathic pain: an anticonvulsant (37%), a tricyclic antidepressant (~30%) and dexamethasone (25%).
. 12% never have access to an anticonvulsant.
. 7% never have access to paracetamol.
. In one main hospital in Malawi, aspirin is the only pain killer which is 'always available'. Aspirin is not recommended in children therefore there are no suitable pain killers available for children.
. Professional training for 71% of the palliative care workers in Asia and 82% in Latin America did not include either pain relief or opioid use.
The report's author, pharmacist Vanessa Adams, notes that the survey findings are likely to greatly over estimate patient access to analgesics as all respondents were actively involved in providing palliative care. In fact in the areas surveyed most of the populations do not have access to any palliative care. For example, in Africa 21 out of 47 countries have no identifiable palliative care provision and only four have a reasonable level of provision. In India less than 1% of the people who would benefit from palliative care have access to it, while in Pakistan there is only one palliative care service to serve a population of 158 million. If healthcare workers wanting to provide palliative care cannot access the required analgesics it is likely that these drugs will be not be available to any other health workers in that country or state.
Barriers to pain relief
The report examines the barriers preventing adequate access to essential analgesics and finds that funding is not the main barrier to access. The cost of medicines such as morphine, although comparatively higher in developing countries than in developed countries, is generally relatively inexpensive. The main reasons for lack of availability include:
. lack of knowledge on the part of healthcare workers, policy makers and the public about the use and benefits of opioid analgesics, other analgesics and palliative care
. excessively strict national laws and regulations
. misplaced fear of addiction, abuse, tolerance and / or side effects
. poorly developed healthcare systems and supply chains.
Comments from survey respondents included:
. "It is simply irrational that oral morphine is not available in the country, whereas expensive fentanyl patches can be made available for the rich patients. Lack of doctors' training, awareness and cure-oriented approach of the society as well as of the medical community makes palliative medicine an unknown field."
. "[There is] fear at all levels of using opioids even when they are available, including among specialist doctors."
. "In my ten years' experience I have never seen a doctor suggest or prescribe opioids other than for cancer patients, and they dismiss out of hand suggestions to consider it for end term AIDS patients, or end stage patients with severe respiratory distress."
Recommendations
In order to prevent millions suffering pain needlessly the report recommends coordinated international and national programmes to increase awareness, education, supply and access. Palliative care and access to analgesics should be an integral part of all national policies relating to cancer, HIV/AIDS and other chronic diseases. The report outlines essential steps that need to be taken to improve access to analgesics including improved education and accountability, reviewing laws and policies and strengthening health facilities.
The report will be available to download in full free of charge from 28th September 2007 at http://www.worldday.org/documents/access_to_pain_relief.pdf.
For more information about the report in advance of its publication on September 28th, please contact Claire Morris, Help the Hospices on +44 207 520 8250 or c.morris@helpthehospices.org.uk.
For media enquiries, to obtain a copy of the report (under embargo until 28th September) or images, please contact: Jo Pratt, Help the Hospices on +44 208 699 6566 or j.pratt@helpthehospices.org.uk.
* It should be noted that the availability of anti-retrovirals does not decrease the need for analgesics.
Notes to editors
. Palliative care, which is the kind of care given in hospices as well as some other settings, improves the quality of life of patients and their families. It aims to provide the best possible care for people living with and dying from a terminal illness and helps prevent and relieve suffering through expert pain and symptom relief as well through practical help, emotional and spiritual support.
. Half of the world's 234 countries have no palliative care services
available to their populations and one third have yet to take the first steps in planning to build service capacity.
. In those countries where hospice and palliative care services are present, provision is mostly localised, with only 15% of countries having achieved a measure of integration with mainstream healthcare service providers.
. There are currently six million cancer deaths and over 10 million new cases of cancer every year, rising to 15 million by 2020.
. It is estimated that 100 million people could benefit from basic palliative care every year. This number is made up of 33 million people dying (60% of the total number dying in the world each year) and their 66 million family members, companions or carers (based on a conservative estimate of two people giving care and support for every person that dies). The actual number of people that receive palliative care is far lower. Although Sub-Saharan Africa has twice as many deaths per 1000 head of population annually as North America, it has only 1.5% of global palliative care resources compared to 55% in North America.
. World Hospice and Palliative Care Day is co-sponsored by the World Health Organization and has been developed by the Worldwide Palliative Care Alliance (a network of national hospice and palliative care organizations) and other global partners. Details of members of the World Day organising group can be found at www.worldday.org/partners.asp.
. The secretariat for World Hospice and Palliative Care Day is provided by Help the Hospices, the UK charity for the hospice movement, which supports over 220 local hospices in their vital work on the front line of caring for people who face the end of life. Hospices provide a wide range of care, from in-patient beds to day care or care for people in their own homes. The UK government contributes an average of 32% of running costs for adult hospices in England and 22% for children's (note: based on latest figures available) - the rest has to be obtained through charitable fundraising.
For more information on Help the Hospices visit www.helpthehospices.org.uk
Jo Pratt
Help the Hospices Press Office
(Tuesdays to Fridays only. For urgent enquiries on Mondays please contact Katie Brewin on 0161 881 7753)
j.pratt@helpthehospices.org.uk
T: 020 8699 6566
M: 07734 566079
www.helpthehospices.org.uk