Access to essential pain medicines an important goal in the fight against NCDS

By Meg O’Brien, PhD, Director, Global Access to Pain Relief Initiative

As we head into the World Health Assembly later this month, there will be a good deal of energy focused on translating the commitments to addressing non-communicable diseases made at last year’s UN High-level Meeting into concrete outcomes for people living and dying with these diseases.
There is one group of people anxiously waiting for us to close our Power Point presentations, wrap up our conference calls, and focus our efforts on securing the essential medicines that are out of their reach. They are the 3.3 million people who die each year of cancer or HIV in moderate or severe pain without treatment and the millions of caregivers who must watch them suffer so unnecessarily.
Opioid analgesics, including morphine, are considered essential medicines by the World Health Organization and are recommended for the treatment of moderate to severe pain. Opioids are also on almost all national essential medicines lists, but access to them is severely limited in most low- and middle-income countries, where 85% of the world’s population consumes just 7% of the medicinal opioids.
There is no more striking example of the global disparity in access to health care than cancer. Cancer patients in low- and middle-income countries lack access to basic diagnostic services and cancer awareness is low, so about 80% of cancer cases are in advanced stages of disease when they are diagnosed. Treatment options are severely limited and where treatment is available, it is less effective in such advanced cases. With a prevalence of about 80% among people with advanced cancer, untreated moderate to severe pain that grows worse each day is a consistent feature of cancer care in resource-limited settings.
Improved access to essential pain medicines is not the only thing that cancer patients in low- and middle-income countries need, but it is arguably the easiest and least expensive need to meet, would do the most to relieve suffering, and recent data suggest may also extend survival. With treatment costs in many programs as low as 1.6 USD per week, the cost of providing 12 weeks of treatment to the 4.3 million people who die of cancer in pain in low and middle-income countries each year is just 83 million USD.
The need for pain relief is not limited to people with cancer. Those with HIV, myocardial infarctions, and people recovering from surgery need it, too. So improving access to essential pain medicines offers an opportunity to move beyond disease-specific silos and build initiatives to address non-communicable diseases that are integrated with – and build on – existing communicable disease programs.
As we look for practical, meaningful, and attainable objectives in the fight to improve care for non-communicable diseases, securing access to essential pain medicines is a no-brainer. The policy framework and clinical guidance are in place; the medicines are plentiful, inexpensive, and effective; the need is great; and the impact will be immediate.

The Global Access to Pain Relief Initiative (GAPRI) is a joint programme of the American Cancer Society (ACS) and the Union for International Cancer Control (UICC) to make effective pain control measures universally available to cancer patients in pain by 2020, in line with Target 8 of the World Cancer Declaration.

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