title: A Systematic Content Analysis of Policy Barriers Impeding Access to Opioid Medication in Central and Eastern Europe: Results of ATOME.
abstract: BACKGROUND
  Reliable access to opioid medication is critical to delivering effective pain management, adequate treatment of opioid dependence, and quality palliative care. However, more than 80% of the world population is estimated to be inadequately treated for pain because of difficulties in accessing opioids. Although barriers to opioid access are primarily associated with restrictive laws, regulations, and licensing requirements, a key problem that significantly limits opioid access relates to policy constraints.
  
  
  OBJECTIVE
  To identify and explore policy barriers to opioid access in 12 Eastern and Central European countries involved in the Access to Opioid Medication in Europe project, funded by the European Community's Seventh Framework (FP7/2007-2013, no. 222994) Programme.
  
  
  METHODS
  A systematic content analysis of texts retrieved from documents (e.g., protocols of national problem analyses, strategic planning worksheets, and executive summaries) compiled, reviewed, approved, and submitted by either the Access to Opioid Medication in Europe consortium or the national country teams (comprising experts in pain management, harm reduction, and palliative care) between September 2011 and April 2014 was performed.
  
  
  RESULTS
  Twenty-five policy barriers were identified (e.g., economic crisis, bureaucratic issues, lack of training initiatives, stigma, and discrimination), classified under four predetermined categories (financial/economic aspects and governmental support, formularies, education and training, and societal attitudes). Key barriers related to issues of funding allocation, affordability, knowledge, and fears associated with opioids.
  
  
  CONCLUSIONS
  Reducing barriers and improving access to opioids require policy reform at the governmental level with a set of action plans being formulated and concurrently implemented and aimed at different levels of social, education, and economic policy change.
authors.affiliation: Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Larjow
authors.affiliation: International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Papavasiliou
authors.affiliation: International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom. Electronic address: s.a.payne@lancaster.ac.uk.
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
authors.affiliation: Willem Scholten Consultancy, Lopik, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Scholten
authors.affiliation: Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
mesh_terms: D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use*; D004493:Education; D005060:Europe; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D059408:Pain Management / Q000191:economics / Q000379:methods / Q000523:psychology; D010166:Palliative Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000523:psychology
chemical_list: D000701:Analgesics, Opioid
keywords: Opioids; harm reduction; pain management; palliative care; policy barriers