There is a stigma of drugs on the streets which is why social attitudes are a big barrier in many of these countries
The five-year project called Access to Opioid Medication in Europe (ATOME), funded by the European Union, looked at why opioid medicines – like morphine and codeine- are not widely available in countries from Poland to Turkey.
The World Health Organisation (WHO) considers opioids to be essential medicines for the treatment of moderate to severe pain, relieving unbearable suffering in illnesses like AIDS and cancer; in the 12 countries surveyed, 300,000 people die from cancer each year.
Opioids also include methadone which is a heroin substitute given to users in an attempt to wean them off the drug and reduce the risk of death through overdose or infection with hepatitis and HIV.
Professor Sheila Payne from the International Observatory on End of Life Care at Lancaster University is one of the authors of the report, who worked closely with specialist teams in each of the 12 countries.
She said: “There is a stigma of drugs on the streets which is why social attitudes are a big barrier in many of these countries. Opioids are treated as narcotics and very strictly controlled because there is a fear that opioids will cause addiction. But if they are used at the end of life or if people are in great pain, addiction is not a problem. In some countries, you can only get opioids if you are in hospital, which is no good if you wish to die at home.”
The review identified potential legal and regulatory barriers in several areas including manufacturing; affordability; trade and distribution; prescribing and dispensing.
Lancaster University worked closely with the WHO to update the national guidance on opioids for each country with Latvia, for example, already passing legislation to enact the changes into law.
Key recommendations include:
- Implement the WHO policy guidelines on controlled medicines
- Identify potential legal and regulatory barriers to access
- Ensure non-stigmatising language in official documents
- Ensure that treatment with opioids is included in the training for doctors, nurses and pharmacists
Professor Payne said: “People hopefully will now have more access to accessible, affordable and available opioid medicines and our report provides a template which can be used not only in Europe but in other parts of the world”.
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