World Hospice and Palliative Care Day is a unified day of action to celebrate and support hospice and palliative care around the world. Ahead of this year’s event on 8 October, Dr Stephen R Connor, Executive Director, Worldwide Hospice Palliative Care Alliance (WHPCA), explains the theme and what we can do to solve the problem.
This year’s World Hospice and Palliative Care Day (WHPCD) theme is ‘Living and dying in pain: It doesn’t have to happen.’ We chose this theme to build on this year’s United Nations General Assembly Special Session (UNGASS) on the World Drug Problem held in New York last April. This year, for the first time, the UN bodies that are responsible for implementing the treaties on drug use, especially the Single Convention on Narcotic Drugs (1961), included a specific section on access to controlled medicines for medical and scientific use.
Getting this section included was a major victory for global palliative care advocates representing patients and their families across the globe, and was not easy or sure to happen. While the Single Convention requires countries to give equal weight to both medical and scientific use, and prevention of misuse, virtually all the focus has been in misuse in the past 55 years. This has led to a situation where even the International Narcotics Control Board has estimated that 75 per cent of the world’s population has no or highly restricted access to these medications for pain relief.
As a result, the WHPCA has estimated that at least 18 million people each year die in moderate to severe pain. There is no good reason why this situation persists! The science of palliative care has grown and developed over the past 50 years and we now have the knowledge and ability to control pain in the vast majority of cases, especially at the end of life. The UNGASS is a first important step to begin to redress this problem but much more is needed for the WHPCD message to be realized.
First, we need all countries to remove burdensome and unnecessary restrictions on access to opioids for medical use. Restrictions such as: limiting the prescribing of opioids to oncologists, limiting the amount prescribed to three or fewer days, limiting the quantity of medicine that can be prescribed per day, limiting only to injectable opioids, or expensive patches. Further unnecessary restrictions include requiring multiple sets of records that duplicate paperwork, putting unreasonable and expensive requirements on pharmacies, requiring the return of used ampoules for witnessed destruction, harassment of prescribing physicians, requiring all patients on opioids to register with the police, and so forth.
Second, all prescribers and health professionals need basic education on palliative care and pain relief. Since the passage of the World Health Assembly resolution on palliative care it is no longer acceptable for physicians, nurses, and other health professionals to graduate from professional school training without having at least a basic knowledge of palliative care and how to assess and treat pain.
Third, we need mechanisms to encourage and facilitate the production of low-cost analgesics such as immediate release morphine tablets or drops. There is very little incentive to pharmaceutical companies to produce and sell opioids since they are so inexpensive to manufacture. Pooled purchasing and other mechanisms are needed.
This is a solvable problem. It will take time and effort but it must be done. While there are real problems with misuse of opioids the real drug problem globally is allowing millions of people to live and die in pain!
Download the World Hospice and Palliative Care Day Toolkit for more information and to help plan your activities.