Lisa Linge-Dahl, Department of Palliative Medicine, University Hospital Bonn, Germany
The last of the 11 national conferences linked to the ATOME project (Access to Opioid Medication in Europe) was held at the Foksal Centre in Warsaw, Poland, on 25 April 2014. More than 60 people attended including scientists and experts from palliative care, pain management and harm reduction, and a journalist.
Access to opioids for harm reduction
“Opioid dependence is conceived of as an illness. People should be free of illegal drugs. Substitution means the constant availability of the patient’s medication. If you stop the medication they will go back to illegal drugs. Let us be realistic. Substitution should not have a limited amount of time,” said Dr Jan Chrostek-Maj (Department of Detoxification, Rydygier Hospital, Kracow), a psychiatrist working with opioid dependent patients.
“Nonetheless OAT (Opioid Agonist Therapy) and opioid therapy in general are still facing lots of obstacles in Poland. Overly restrictive laws, insufficient medical education in pain treatment, fear of dependence, attitudes of relatives, inadequate medical education and opiophobia among doctors are some of the reasons.”
Underlining this statement, a patient who was in a substitution therapy programme described her personal experiences with OAT. Despite being grateful for the opportunity to get methadone, she wanted more self-control and privacy and did not like having to obtain her medicines daily at the clinic. Due to the strictly regulated treatment, it is quite difficult for people to have a ‘normal’ daily routine. She said that she “felt alienated and over-scrutinised and did not have anyone to turn to for help”. Other barriers for OAT are the lack of programmes in rural areas.
Access to opioids for pain treatment
In a global comparison, Poland is one of the countries with an advanced developed integration of palliative care; nearly all strong opioids are available and fully reimbursed. Unfortunately, however, this applies only for cancer patients, and overall Poland’s opioid consumption rates are quite low. Marlena Ewa Kazon of the Patient Foundation, Chrustka, (‘Nobody should suffer’), stated:
“We highlight inconsistent pain treatment situations to raise the awareness of doctors. We try to encourage patients to fight for their rights. In the Polish society there are still a lot of prejudices against opioids.”
So even if Poland is highly developed in palliative care, the ATOME conference showed that there are still fields such as harm reduction and treatment of non-cancer patients where a lot needs to be done. The conference brought together people from various fields and hopefully marked the starting point for cooperation and improvement.
Concluding the symposium, Dr Willem Scholten, a World Health Organization Consultant for Medicines and Controlled Substances, urged conference participants to take on the fight to improve the situation in their country. The ATOME consortium will send a report on the outcomes and recommendations of ATOME activities to the Polish Minister of Health in autumn 2014.
Links and resources
- Access to Opioid Education in Europe ATOME
- Click here to read previous reviews of ATOME conferences on the EAPC blog.