Antea Worldwide Palliative Care Conference

Rome, 12-14 November 2008

ABSTRACT FORM

Presenting author THE WORLD HEALTH ORGANIZATION, PALLIATIVE CARE AND ACCESS TO
OPIOID ANALGESICS
Willem Scholten
Email: Authors (max 6, presenting author included): Willem Scholten
ScholtenW@who.int
Access to adequate analgesia is among the most important aspects of palliative care, but also
Phone among the most challenging aspects in most countries. WHO estimates that annually about
4 million cancer patients and 0.8 million HIV/AIDS patients suffer moderate to severe pain that
is not well addressed.
Mobile phone Barriers to opioid analgesia are many and all of them have to be removed before patients will
experience a difference. If health care workers are aware of the existence of these barriers, they
can more easily improve chances that patients will receive adequate treatment. These barriers
will be discussed and information will be given that could help health-care professionals to
Please underline the most overcome them.
appropriate category for your
abstract - Legislative barriers: countries often apply more restrictive rules on opioids for medicinal use
than they are obliged to from the international drug control treaties. Examples will be given.
• Pain and other symptoms
- Policy barriers: not all governments realize that patients have a right to essential medicines
• Palliative care for cancer patients that are also controlled under the international drug control conventions. National policy plans
• Palliative care for non cancer like a pharmaceutical policy plan, a cancer policy plan or a HIV policy plan should include
patients access to these medicines. National policies should aim for a balance between prevention of
• Paediatric palliative care abuse and dependence and a good access for medical use. Civil servants involved in importation
• Palliative care for the elderly
procedures should have an understanding of these matters and should be well trained for their
duties.
• The actors of palliative care
- Knowledge barriers: in many countries health-care professionals do not have sufficient
• Latest on drugs knowledge on how to prescribe opioids and often they have an exaggerated fear for the side
• Pain effects. Often, a major cause is that the training institutions for health-care workers do not
include any training on opioid analgesia.
• Illness and suffering through - Attitude barriers: These barriers are closely related to knowledge barriers. They include the fear
media for dependence, a misunderstood relation between death and the use of opioid analgesics, and a
cultural, spiritual or religious interpretation of the place of suffering in life.
• Marginalisation and social stigma
at the end of life
For all health-care workers, it is important to have a good knowledge of opioid prescribing. They
• Palliative care advocacy projects
should be well-trained to address attitude barriers among colleagues, patients and their families.
• Prognosis and diagnosis They should have a response specific for local cultural, spiritual or religious attitudes that
communication in prevent to address the patient's pain adequately.
different cultures
For the system related barriers it is not necessary that every health-care worker has a
• Communication between doctor- comprehensive knowledge. However, to interact adequately with government officials, it is
patient and patient- necessary that some, mainly academic, professionals have an understanding of certain aspects.
equipe
• Religions and cultures versus
suffering, death and
bereavement
• Public institution in the world:
palliative care policies
and law
• Palliative care: from villages to
metropolies
• Space, light and gardens for the
terminally ill patient
• End-of-life ethics Opening Ceremony
• Complementary therapies
• Education, training and research
• Fund-raising and no-profit
• Bereavement support
• Volunteering in palliative care
• Rehabilitation in palliative care
• Palliative care quality indicators