title: A Multifaceted Approach to Improve the Availability and Accessibility of Opioids for the Treatment of Cancer Pain in Serbia: Results From the International Pain Policy Fellowship (2006-2012) and Recommendations for Action.
abstract: Cancer is the second leading cause of death in Serbia, and at least 14,000-16,000 patients experience moderate-to-severe cancer pain every year. Cancer pain relief has been impeded by inadequate availability of opioid analgesics and barriers to their accessibility. In 2006, a Serbian oncologist was selected as an International Pain Policy Fellow. The fellow identified barriers to opioid availability in Serbia and implemented an action plan to address the unavailability of oral morphine, attitudinal and knowledge barriers about opioids, and barriers in the national opioid control policy, in collaboration with the government, local partners, and international experts, including those from the World Health Organization. Collaborative efforts resulted in availability of immediate-release oral morphine, registration of controlled-release hydromorphone, and reimbursement of oral methadone for cancer pain; numerous educational activities aimed at changing inadequate knowledge and negative attitudes toward opioids; recognition of opioids as essential medicines for palliative care in a new National Palliative Care Strategy; and recognition of the medical use of opioids as psychoactive-controlled substances for the relief of pain included in a new national law on psychoactive-controlled substances, and the development of recommendations for updating regulations on prescribing and dispensing opioids. An increase in opioid consumption at the institutional and national levels also was observed. This article outlines a multifaceted approach to improving access to strong opioids for cancer pain management and palliative care in a middle-income country and offers a potential road map to success.
authors.affiliation: Department of Supportive Oncology, Oncology Intensive Care Unit, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
authors.forename: Snezana M
authors.initials: SM
authors.lastname: Bosnjak
authors.affiliation: Pain & Policy Studies Group, Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin, USA. Electronic address: mamaurer@uwcarbone.wisc.edu.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Maurer
authors.affiliation: Research and Sponsored Programs, University of Wisconsin, Madison, Wisconsin, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Ryan
authors.affiliation: Hospital Pharmacy, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Popovic
authors.affiliation: Pain & Policy Studies Group, Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin, USA.
authors.forename: S Asra
authors.initials: SA
authors.lastname: Husain
authors.affiliation: Pain & Policy Studies Group, Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Cleary
authors.affiliation: Willem Scholten Consultancy, Medicines and Controlled Substances, Lopik, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Scholten
mesh_terms: D000701:Analgesics, Opioid / Q000600:supply & distribution* / Q000627:therapeutic use*; D000072716:Cancer Pain / Q000188:drug therapy*; D005257:Fellowships and Scholarships; D006266:Health Education; D006291:Health Policy; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence; D006801:Humans; D010166:Palliative Care / Q000331:legislation & jurisprudence; D058996:Quality Improvement; D055771:Serbia
chemical_list: D000701:Analgesics, Opioid
keywords: Cancer pain; Europe; Serbia; laws; opioids; regulations