title: Toward safe accessibility of opioid pain medicines in Vietnam and other developing countries: a balanced policy method.
abstract: Moderate or severe pain is common among people with advanced cancer and other life-threatening illnesses. Yet despite agreement that pain relief is a human right, the poorest 80% of the world's population rarely have access to strong opioid analgesics. Excessively restrictive opioid policies, especially in developing countries, both stem from and propagate misguided fears about opioids, so-called opiophobia. Because opiophobia, like any norm, is historically, socially, and culturally situated, efforts to change opiophobic policies will be most effective if guided by awareness of their historical, social, and cultural determinants. We describe some of these determinants in Vietnam and report on results of an ongoing project there to allay opiophobia and improve safe access to opioids for medical uses. We used a method that entails working with committed local partners, including a high-level official from the Ministry of Health, to review all Vietnamese policies governing opioid accessibility to identify the barriers; devising an action plan to safely reduce or circumnavigate the barriers; obtaining buy-in for the plan from all stakeholders, including drug regulators and the police; and assisting the Ministry of Health to implement the plan. Since the start of the project, morphine consumption has increased each year and as of 2010 was ninefold greater than in 2003, and the number of hospitals offering palliative care has increased from three to 15. We conclude that this balanced policy method appears to be helping to reduce barriers to opioid access in Vietnam and should be used in other developing countries.
authors.affiliation: Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts, USA. Electronic address: ekrakauer@hms.harvard.edu.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Krakauer
authors.affiliation: Centre for Community Health Development, Hanoi, Vietnam.
authors.forename: Thi Phuong Cham
authors.initials: TP
authors.lastname: Nguyen
authors.affiliation: Pain & Policy Studies Group, Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin, USA; World Health Organization Collaborating Center for Pain Policy in Palliative Care, Madison, Wisconsin, USA.
authors.forename: Syeda Asra
authors.initials: SA
authors.lastname: Husain
authors.affiliation: Vietnam Administration of Medical Services, Ministry of Health, Hanoi, Vietnam.
authors.forename: Thi Hai Yen
authors.initials: TH
authors.lastname: Nguyen
authors.affiliation: Pain & Policy Studies Group, Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Joranson
authors.affiliation: Vietnam Administration of Medical Services, Ministry of Health, Hanoi, Vietnam.
authors.forename: Ngoc Khue
authors.initials: NK
authors.lastname: Luong
authors.affiliation: Pain & Policy Studies Group, Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin, USA; World Health Organization Collaborating Center for Pain Policy in Palliative Care, Madison, Wisconsin, USA.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Maurer
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003906:Developing Countries / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence / Q000458:organization & administration; D006291:Health Policy / Q000331:legislation & jurisprudence / Q000639:trends*; D006293:Health Promotion / Q000331:legislation & jurisprudence / Q000458:organization & administration; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000331:legislation & jurisprudence / Q000458:organization & administration; D014744:Vietnam / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid
keywords: AIDS; Pain; cancer; global health; morphine; opioid; palliative care; policy