WHO: Don’t Forget Needs of Patients in Pain When Formulating Drug Control Policies

Countries need to be cognizant of the suffering of patients in pain when formulating plans to cut down on prescription drug abuse, according to the new World Health Organization’s (WHO) guidelines on balanced drug control policies.

The guidelines, “Ensuring Balance in National Policies on Controlled Substances,” aim to strike a balance between preventing substance abuse and dependence, and helping people in pain get needed access to controlled medicines, says Willem Scholten, Team Leader, Access to Controlled Medicines at the WHO.

“If you restrict prescriptions for people who need them, you’re not addressing the real problem and you are creating a new problem of untreated pain,” Scholten says. “In many cases there is no good alternative to opioid pain relievers, so you cannot just cut patients off who need them for pain relief.”

WHO estimates that every year 5.5 million terminal cancer patients worldwide suffer moderate to severe pain that is not managed at all. Additionally, tens of millions of people experience unrelieved pain from diseases and conditions other than cancer. These people require access to medicines, many of which are controlled, to relieve pain. The WHO guidelines note that there is a broad consensus that opioid analgesics are indispensable for the treatment of moderate to severe pain.

“While the majority of the world has no good access to pain treatment, even in developed nations many patients say they are not sufficiently treated for their pain. A recent study showed that in the Netherlands, a country considered to be reasonably good at pain management, 79% of patients believed their pain not to be well addressed [1],” Scholten notes.

The guidelines state that while misuse of controlled substances poses a risk to society, governments should not set up a system of control that bars their availability for medical and scientific purposes, or interferes in their legitimate medical use for patient care.

There has been a substantial increase in the use of opioids in developed countries, but the availability of these drugs in developing countries has remained very low and is far from adequate in meeting the medical needs of their populations, according to the WHO.

In some countries, laws and regulations intended to prevent the misuse of controlled substances are overly restrictive and interfere with patient access to medical treatment with such substances. The WHO says that such situations can arise when not enough attention is paid to the impact of regulations on the supply of controlled substances for medical purposes.

One issue that governments should pay closer attention to is insurance coverage for pain medication, according to Scholten. “The cost of medication is an issue that can impact use and abuse of pain medicines. For instance, some doctors might prescribe medication that is less expensive so patients can have access to it, but at the same time harder to find the right dose. If they themselves are not properly trained in the use of that medication, this can lead to overdoses.”

Physician training is very important in a balanced drug policy, Scholten emphasized. “Doctors need to be well trained in how to prescribe and dose pain medications, while keeping in mind that patients might abuse these drugs. They need to evaluate patients for risk factors for abuse, and those who are found to be at risk of abusing prescription drugs can be monitored more closely.”

The WHO recommends that all physicians should be sufficiently trained to assess the levels of pain and to treat pain, and that the ability to prescribe opioids should not be restricted to a small number of medical specialties such as oncology. The guidelines state that the amount of medicine prescribed, appropriate formulation and duration of treatment should be the practitioner’s decision, based on an individual patient’s needs and on sound scientific medical guidance. The report advises against legal restrictions on the maximum daily dosage of strong opioids, or limiting the use of strong opioids only to certain conditions such as cancer pain or terminal cancer pain.

The guidelines include a Country Assessment Checklist designed to help government officials analyze their national drug control policies and the extent to which the WHO guidelines are adhered to in their country.

1. Bekkering GE et al, Epidemiology of chronic pain and its treatment in the Netherlands. The Netherlands J of Med. 2011; 69(3): 141 – 152

3 Responses to WHO: Don’t Forget Needs of Patients in Pain When Formulating Drug Control Policies

  1. Ben House | August 2, 2011 at 2:20 pm

    I have worked in health care for over forty years and my partner is an RN on a med/surg unit. We often discuss pain management and find the biggest barrier is an accurate understanding of pain, its subjective nature and the many faces of pain: physical, social, psychological, spiritual, and others. Health care professionals need training in understanding pain itself. The doctor prescribes opiates, the psychiatrist antidepressants, the friend tells you get another partner, and the pastor encourages prayer. Understanding pain means understanding its many faces rather than the dogmatic one sided approach that so often is practiced. Those who lack accurate empathy tend to be abusive in their relationships.

  2. Lisa, Families of Addiction | August 8, 2011 at 8:17 am

    I am very glad to see this topic arise. My brother died 3 years ago from a heroin overdose. He was given pain medication for a work related injury and when his health care provider discontinued the medication, he turned to street drugs for pain relief. I think the balanced approach to drug control would be beneficial. Does anyone know if there are going to be any efforts in America to adopt any of these strategies?

  3. susan tiller | June 28, 2013 at 9:57 pm

    I HAVE BEEN IN PAIN SINCE I HAD A ACCIDENT AT A FIRE STATION I WAS WORKING ON.I WAS A COMMERCIAL PAINTER TIL 11/12/02.LIFE FOR ME HAS BEEN CRUEL…MY NERVES ARE DAMAGED SO BAD IT WOULD BE IMPOSSIBLE TO EXPLAIN THE LEVEL OF PAIN I LIVE WITH.IAM GOING TO A PAIN CLINIC AND THEY HAD MY PAIN CONTROLLED.WHEN ALL THESE FAMOUS PEOPLE AND ALL THE GREEDY PEOPLE [OXY HWY]EVERYTHING HAS CHANGED.THE GOV&DEA ARE GIVING THE DR’S SUCH A HARD TIME THEY ARE AFRAID TO PRESCRIBE THE DOSAGE IT TAKES TO HELP ME.I NOW SIT OR LAY DOWN THESE DAYS.I DON’T GO SHOPPING OR WALK MY DOGS,CLEAN,WASH CLOTHES,NOR EAT OUT I CAN’T MAKE LOVE TO MY HUSBAND.I’M A PROUD WOMAN NOT BEING ABLE TO DO THESE THINGS HAS MADE ME FEEL WORTHLESS.AND THE LEVEL OF PAIN AND WHATS GOING ON WITH THE DEA+GOV AND DR’S I NOW DON’T SEE A LIGHT AT THE END OF THE TUNNEL.IT TAKES EVERY PART OF MY FAITH AND MY BELIEFS AND THE FACT THAT MY HUSBAND AND SONS NEED ME EVEN THOUGH THEY HAVE TO TAKE CARE OF ME.IF NOT FOR THEM I WOULD NOT LIVE LIKE THIS ANY LONGER.I AM CONSUMED BY PAIN.NO ONE WOULD BE ABLE TO OR EXPECTED TO LIVE LIKE THIS.IF THEY HAD MY LEVEL OF PAIN.I HOPE AND PRAY THEY COME UP WITH SOMETHING THAT WORKS FOR EVERYONE.

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