"Perspectives of former International Pain Policy Fellows" 

"Perspectives of former International Pain Policy Fellows" 

Prof. Snežana Bošnjak, MD, PhD Prof. Snežana Bošnjak, MD, PhD

Institute for Oncology and Radiology of Serbia (IORS)

Belgrade, Serbia

Institute for Oncology and Radiology of Serbia (IORS)

Belgrade, Serbia

Dual nature of opioids Dual nature of opioids

Essential medicines

• Moderate to severe pain • Tx of opioid dependence

Accessible

Narcotics

Potential to be abused

Inaccessible

Controlled

Action plan: identify issues Action plan: identify issues

• Oral morphine unavailable • Neglected need for / concerns about morphine• Lack of recognition that it is Government`s

obligation to ensure that opioids are available and accessible for patients (dual obligation)

• Overly restrictive policies that govern the use of opioids

• Oral morphine unavailable • Neglected need for / concerns about morphine• Lack of recognition that it is Government`s

obligation to ensure that opioids are available and accessible for patients (dual obligation)

• Overly restrictive policies that govern the use of opioids

Create demand for morphine Create demand for morphine

Educate that oral morphine is

Indispensable for Tx of moderate to severe cancer pain

Appropriate for every phase of the disease

Safe when used as recommended by available guidelines

Convenient: variety of formulations

Educate that oral morphine is

Indispensable for Tx of moderate to severe cancer pain

Appropriate for every phase of the disease

Safe when used as recommended by available guidelines

Convenient: variety of formulations

Create demand for morphine Create demand for morphine

Change negative attitude

Address concerns about addiction, tolerance, side effects of morphine

Address fears that morphine implies the final stage of the disease

Change negative attitude

Address concerns about addiction, tolerance, side effects of morphine

Address fears that morphine implies the final stage of the disease

Create demand for morphine Create demand for morphine

• Inform about moral obligation to prevent people from suffering if suffering is preventable

• Inform about right to pain relief as a human right

• Request help from Ombudsman

• Inform about moral obligation to prevent people from suffering if suffering is preventable

• Inform about right to pain relief as a human right

• Request help from Ombudsman

Counter-Campaign: why morphine?Counter-Campaign: why morphine?

• Why spending money on morphine, when  the drug is not “popular” any more

• There are other, “less frightening” alternatives to morphine

• The consumption of morphine is declining all over the world

• Why spending money on morphine, when  the drug is not “popular” any more

• There are other, “less frightening” alternatives to morphine

• The consumption of morphine is declining all over the world

Textbook Pharmacotherapy

of cancer pain

Textbook Pharmacotherapy

of cancer pain

ProfessionalsProfessionals Patient / family Patient / family

Educative poster on right to pain relief as a human right

Educative poster on right to pain relief as a human right

Educative poster on opiophobia for patients

Working with Government Working with Government

• How to balance obligation to protect against abuse and dependence with the equally important responsibility to ensure opioids for pain relief and effective palliative care ?

• Inform about legal, political, public health and moral grounds for dual obligation

• Explore possibility to participate in decision-making bodies

• How to balance obligation to protect against abuse and dependence with the equally important responsibility to ensure opioids for pain relief and effective palliative care ?

• Inform about legal, political, public health and moral grounds for dual obligation

• Explore possibility to participate in decision-making bodies

Change overly restrictive drug control policies

Change overly restrictive drug control policies

• Drug regulators educated that the main (only?) goal of drug control policies is to prevent abuse and dependence

• No provision that recognizes that opioids are absolutely necessary for the relief of pain & suffering

• Presentation, communication, negotiation skills• Be prepared, work with PPSG staff, use available

resources (WHO 2011 policy guidelines)

• Drug regulators educated that the main (only?) goal of drug control policies is to prevent abuse and dependence

• No provision that recognizes that opioids are absolutely necessary for the relief of pain & suffering

• Presentation, communication, negotiation skills• Be prepared, work with PPSG staff, use available

resources (WHO 2011 policy guidelines)

Building support (internal) Building support (internal)

• Interviews with practicing clinicians, pharmacists, patients/families, caregivers

• Interviews with government drug regulators• Professional societies (oncology, hematology, pharmacology,

pain) • NGOs • Pharmaceutical companies• Influential individuals who have had recent positive

experiences w/opioid use• Media

• Interviews with practicing clinicians, pharmacists, patients/families, caregivers

• Interviews with government drug regulators• Professional societies (oncology, hematology, pharmacology,

pain) • NGOs • Pharmaceutical companies• Influential individuals who have had recent positive

experiences w/opioid use• Media

Building support (external) Building support (external)

• PPSG mentor (s)

• Other mentors: WHO, IAHPC, EAPC, OSI, HRW

• International experts / initiatives / resources

• Your colleague Fellows

• ATOME project

– Member of AAB

– Member of WHO 2011 guidelines development group

• PPSG mentor (s)

• Other mentors: WHO, IAHPC, EAPC, OSI, HRW

• International experts / initiatives / resources

• Your colleague Fellows

• ATOME project

– Member of AAB

– Member of WHO 2011 guidelines development group

Conclusion Conclusion

• Identify issues

• Develop possible solutions

• Seek collaboration and partnership

• Build support

• Capitalize on opportunity

• Identify issues

• Develop possible solutions

• Seek collaboration and partnership

• Build support

• Capitalize on opportunity