Saskia Jünger, health scientist at the University Hospital of Bonn, Germany, and member of the ATOME Project Management Team.
A touch of summer, with a glittering sun over the Danube – majestic scenery for the 6th national ATOME conference on improving access to opioid medication held on 26 April 2013 in Budapest, Hungary. Dr Hanna Páva, Deputy Secretary of State, officially opened the conference and highlighted recent improvements to the availability and accessibility of opioids in Hungary. While until recently Hungarian opioid policy had focused on control rather than education or access, the updated WHO policy guidelines  had prompted the government to take legislative action by reducing excessive bureaucracy and red tape.
Training, protocols, attitude – overcoming ‘opioiphobia’
Throughout the conference there was strong emphasis on the need for more systematic education on treatment of pain and opioid dependence. Notably, one working group was called ‘Training, protocols, attitude’, reflecting the Hungarian experts’ perception of the strong link between these factors.
“Health care professionals’ attitudes towards opioids play a key role in promoting policy change and improved access since many clinicians still associate opioid therapy with end stage terminal illness rather than best practice pain control,” said Dr Páva. Notably, the average number of hours of pain content in undergraduate medical studies in Europe appears to be higher for veterinary science than for human medicine, as Dr András Telekes, oncologist and university professor, pointed out. Dr Erica Budai, head physician of the pain department at the Jahn Ferenc Hospital, deplored a widespread lack of empathy: “Often, neither politicians nor we as physicians and nurses fully understand the social implications of pain for patients. The pain does not hurt us – so we do not care.”
Taboos around harm reduction
Mr Peter Sarosi, drug policy programme director of the Hungarian Civil Liberties Union, talked about the taboos related to harm reduction approaches in Hungary. In the 1990s, physicians who applied opioid substitution faced the risk of prosecution against them. There had also been resistance against needle exchange programmes. The government started supporting these programmes around the year 2000; however, there is still a legal uncertainty among healthcare providers regarding the provision of sterile syringes. Also, reimbursement of pharmacological treatment is insufficient. The right dosage of methadone maintenance is of key importance to eliminate craving, not just withdrawal symptoms, otherwise relapse or additional illicit opioid consumption is likely to follow. At the moment, subsidy for methadone only covers 8mg/day while it is well known that the appropriate treatment dose is at least 12 – 14 mg/day. Peter Sarosi noted that “every single Dollar, Forint or Euro invested in harm reduction programmes will save at least four Dollars, Forints or Euros for the society.”
Critical mass to make a change
Eva Luxné Gecső, senior counsellor at the Ministry of Human Resources and leader of the Hungary ATOME country team, encouraged the delegates’ engagement during their small group work in the afternoon of this one-day conference: “Although the ATOME project is almost at its completion we must not get tired because the work is actually only beginning.” Dr Willem Scholten supported this momentum in his closing words, reflecting on everyone’s contribution in improving access to opioid medication.
“We are not only the policy makers or the physicians, but we are also the patients and the relatives themselves in the end. That’s why every policy maker should have an interest in ensuring good opioid treatment. The investment in appropriate opioid availability is always paying back.” He appealed to people’s influence and ability to make a change.
“If you go home and forget about the work today, nothing will happen. But if you continue to think about it, you can start discussing the topic in the boards of professional organisations or writing about it in professional journals – you can generate a critical mass in the Hungarian society.”
1. WHO Policy Guidelines Ensuring Balance in National Policies on Controlled Substances, Guidance for Availability and Accessibility for Controlled Medicines.
To find out more …
Click here to read a blog post by Dr Katalin Hegedus and Dr Agnes Csikos that elaborates on some of the issues raised here. You can also read more about other ATOME conferences and activities on the EAPC blog.
Join us in Prague…
To learn more about ATOME please come to the session ‘Regulatory Barriers in Palliative Care Opioid Treatment’ highlighting key findings from the ATOME policy and legislation review and their implications for palliative care practice. It’s on Saturday, 1 June 2013 at 16.30 – 18.00; Parallel Symposium (PS22), Meeting Hall IV. You can now download the final programme for Prague 2013.