Lukas Radbruch, Coordinator of the EU-funded ATOME project
A new publication in the prestigious New England Journal of Medicine on painful inequities describes the barriers that prevent adequate pain treatment in resource-poor countries (Lamas D, Rosenbaum L. Painful inequities –palliative care in developing countries. N Engl J Med 2012; 366: 199-201.).
Recognising this problem, the ATOME consortium aims to improve access to opioid medications in 12 eastern and southern European countries. The experts of the ATOME consortium are meeting just now in Bonn, Germany, to discuss new and ongoing developments.
To provide guidance for governments, ATOME has revised the World Health Organization guidelines on ensuring balance in national policies on controlled substances. A scan of legislation found various legal and regulatory barriers, mostly on prescribing and dispensing of opioid medications. Stigmatising language such as ‘addictive drugs’ was used frequently in legal documents.
However, legislation is only one side of the problem. A multitude of barriers, including negative attitudes and fear of prosecution, prohibits pharmacists from dispensing and physicians from prescribing analgesics. This was evident from two six-country workshops held in Bucharest last year. Collaboration of clinicians and decision makers is paramount to introduce change. ATOME has set up within-country teams that have developed action plans for each country. A series of conferences will follow up on these action plans, starting with a one-day national conference in Slovenia on 20 March 2012.
We definitely need more research to describe the specific problems and barriers in each country and, more important, to identify ways to overcome them. The ATOME consortium is currently doing such research, and I would like to invite you to participate in the discussion on ongoing research in the research clinic session at the next EAPC Research Congress in Trondheim (9 June 2012, 18.00-19.00).