Opioid availability and palliative care in Nepal: influence of an international pain policy fellowship.
Globally, cancer incidence and mortality are increasing, and most of the burden is shifting to low- and middle-income countries (LMICs), where patients often present with late-stage disease and severe pain. Unfortunately, LMICs also face a disproportionate lack of access to pain-relieving medicines such as morphine, despite the medical and scientific literature that shows morphine to be effective to treat moderate and severe cancer pain. In 2008, an oncologist from Nepal, one of the poorest countries in the world, was selected to participate in the International Pain Policy Fellowship, a program to assist LMICs, to improve patient access to pain medicines. Following the World Health Organization public health model for development of pain relief and palliative care, the Fellow, working with colleagues and mentors, has achieved initial successes: three forms of oral morphine (syrup, immediate-release tablets, and sustained-release tablets) are now manufactured in the country; health-care practitioners are receiving training in the use of opioids for pain relief; and a new national palliative care association has developed a palliative care training curriculum. However, long-term implementation efforts, funding, and technical assistance by governments, philanthropic organizations, and international partners are necessary to ensure that pain relief and palliative care become accessible by all in need in Nepal and other LMICs.
National Academy of Medical Sciences, Bir Hospital, Ministry of Health, Kathmandu, Nepal.
Bishnu Dutta
BD
Paudel
Research and Sponsored Programs, University of Wisconsin, World Health Organization Collaborating Center for Pain Policy in Palliative Care, Madison, Wisconsin, USA.
Karen M
KM
Ryan
Pain & Policy Studies Group, University of Wisconsin Carbone Cancer Center, World Health Organization Collaborating Center for Pain Policy in Palliative Care, Madison, Wisconsin, USA.
Mary Skemp
MS
Brown
Department of Global Health & Social Medicine, Harvard Medical School and Palliative Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Eric L
EL
Krakauer
Trivandrum Institute of Palliative Care, Pallium India/World Health Organization Collaborating Center for Training and Policy on Access to Pain Relief, Trivandrum, India.
M R
MR
Rajagopal
Pain & Policy Studies Group, University of Wisconsin Carbone Cancer Center, World Health Organization Collaborating Center for Pain Policy in Palliative Care, Madison, Wisconsin, USA. Electronic address: mamaurer@uwcarbone.wisc.edu.
Martha A
MA
Maurer
Pain & Policy Studies Group, University of Wisconsin Carbone Cancer Center, World Health Organization Collaborating Center for Pain Policy in Palliative Care, Madison, Wisconsin, USA.
James F
JF
Cleary
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005257:Fellowships and Scholarships; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D038622:Internationality; D007880:Legislation, Drug; D009020:Morphine / Q000627:therapeutic use; D009390:Nepal; D010166:Palliative Care / Q000331:legislation & jurisprudence / Q000379:methods* / Q000706:statistics & numerical data*; D011203:Poverty
D000701:Analgesics, Opioid; D009020:Morphine
International Pain Policy Fellowship; Low- and middle-income countries; Morphine; Nepal; opioid availability