title: Evaluation of the Effectiveness of Workshops on the Availability and Rational Use of Opioids in Latin America.
abstract: Many patients around the globe do not have access to pain treatment. A series of workshops on the availability and rational use of opioids in Latin America (LA) were implemented.
  
  
  
  To evaluate the effectiveness of action plans (APs) resulting from workshops to eliminate barriers to the availability and accessibility of opioids in 13 Latin American countries (Bolivia, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Peru, and Venezuela). Effectiveness was measured qualitatively and quantitatively.
  
  
  
  A cross-sectional study was conducted from September to October 2015. Outcome variables were qualitative: the country coordinators (CCs) perceived workshop benefit and effectiveness and ability to implement the resulting AP and quantitative: (1) 2013 opioid consumption; (2) opioid consumption change from 2010 to 2013; (3) formulations available. For analysis we used nonparametric tests [Wilcoxon, Mann-Whitney, Spearman correlation (Rs)] and content analysis.
  
  
  
  Qualitative: 10 CCs rated the workshop very useful or useful and the resulting AP helpful in eliminating barriers. Communication/collaboration with regulators improved in 11 countries. Content, organization, and methodology were rated positively. Quantitative: no significant difference was found between countries that had one, two, or no workshops and the outcome variables. A positive significant correlation was found between Human Development Index and consumption (Rs [Spearman's rank correlation coefficient] = 0.688; p = 0.009) and in consumption changes: (Rs = 0.445; p = 0.128), but not in number of formulations available.
  
  
  
  The APs were rated useful in eliminating barriers but only four countries were able to implement >75% of their APs, which may suggest that the barriers were overwhelming and beyond their means to eliminate.
  
  
  
  Limited access to pain treatment is multifactorial, including restrictive laws and regulations. Strategies to eliminate barriers need to be broad and include clinical and government representatives to be effective. It may take several years before results are observed.
authors.affiliation: 1 International Association for Hospice and Palliative Care (IAHPC) , Houston, Texas.
authors.forename: Liliana
authors.initials: L
authors.lastname: De Lima
authors.affiliation: 2 Department for Palliative Medicine, Medical Faculty, RWTH Aachen University , Aachen, Germany .
authors.forename: Tania
authors.initials: T
authors.lastname: Pastrana
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D006801:Humans; D007843:Latin America
chemical_list: D000701:Analgesics, Opioid