“ Balance ”

1. “Balance” Jim Cleary, MD Associate Professor of Medicine Director, Palliative Care Medicine, UW Hospital & Clinics Director, WHO Collaborating Center for Pain Policy and Palliative Care

2. Establishes a Framework to: • Prevent abuse and diversion, and • Ensure the availability of drugs for medical purposes

6. “Balance”

7. “the medical use of narcotic drugs continues to be indispensable for the relief of pain and suffering… adequate provision must be made to ensure the availability of narcotic drugs for such purposes.” (Preamble, p. 13)

8. INCB Concern “The low levels of consumption of opioid analgesics for the treatment of pain in many countries, in particular in developing countries, continue to be a matter of serious concern to the Board. The Board again urges all Governments concerned to…take steps to improve the availability of those narcotic drugs for medical purposes…” (INCB 2007 Annual Report, p. 20)

9. Why is opioid use so low? 1995 Survey of government drug control authorities – 65 countries Impediments to opioid availability: Fear of addiction Lack of training Excessively restrictive laws and regulations Fear of legal consequences Insufficient amount of opioids Cost of opioids Inadequate health care resources Lack of national policy, guidelines International Narcotics Control Board. (1996). Report of the International Narcotics Control Board for 1995: Availability of Opiates for Medical Needs. New York, NY: United Nations.

10. Why is opioid use so low? Adams, V. (2007). Access to Pain Relief – an essential human right. Help the Hospices, Worldwide Palliative Care Alliance. 2006 Survey of Health care workers, and hospice/PC staff in Asia, Africa and Latin America Barriers to accessing oral morphine: Excessively strict national drug laws and regulations; Fear of addiction; Poorly developed health care systems; Lack of knowledge

11. 1) Opioid Regulatory Policy 2) Drug Distribution System 3) Cost of Opioid Analgesics 4) Knowledge & Attitudes Barriers

12. Achieving Balance in National Opioids Control Policy: Guidelines for Assessment (2000) • For governments and health professionals • Explains need, rationale and imperative • 16 criteria • Simplified Checklist • 22 Languages

13. “Balance” is the Fundamental Principle National policy should establish a drug control system that prevents diversion and ensures adequate availability for medical use Drug control measures should not interfere with medical access to opioid

14. www.painpolicy.wisc.edu Arabic Bulgarian Chinese English French German Hindi Indonesian Italian Lithuanian Mongolian Polish Portuguese Romanian Russian Serbian Spanish Swahili Tagalog Turkish Ukrainian Vietnamese Документ № WHO/EDM/QSM/2000.4 СТАТУС ДОКУМЕНТА: ЗАГАЛЬНИЙ WORLD HEALTH ORGANIZATION ВСЕСВІТНЯ ОРГАНІЗАЦІЯ ОХОРОНИ ЗДОРОВ’Я НАРКОТИЧНІ ТА ПСИХОТРОПНІ ПРЕПАРАТИ ДОСЯГНЕННЯ ВІДПОВІДНОСТІ НАЦІОНАЛЬНИХ ПОЛІТИК КОНТРОЛЮ ЗА ЗАСТОСУВАННЯМ ОПІОЇДІВ РЕКОМЕНДАЦІЇ ЩОДО ОЦІНЮВАННЯ WORLD HEALTH ORGANIZATION ВСЕСВІТНЯ ОРГАНІЗАЦІЯ ОХОРОНИ ЗДОРОВ’Я

15. WHO Public Health Model__________________________ DrugAvailability Education Policy

16. Consumption of Morphine 1980 - 2003 East vs. West Europe (mg/capita/yr) mg/capita

17. Joranson, Lancet 2006 World Health Organization Collaborating Center
for Pain Policy and Palliative Care