SCOPING QUESTION: In the management of prescription opioid dependence, does supervised dosing with a long-acting opioid medication result in less opioid
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use and related harms than non-prescription, detoxification or usual care?
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Millennium Development Goal 8E aims for affordable access to essential medicines. Essential medicines, as defined by WHO, are those that “satisfy the health-care needs of the majority of the population” and that should therefore “be available at all times in adequate amounts”. However, there
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is a category of medicines that faces a unique challenge in terms of availability. These are the medicines governed by the international conventions on narcotic and psychotropic substances. “Controlled medicines” is the common definition for pharmaceuticals whose active principles are listed under the 1961 United Nations Single Convention on Narcotic Drugs as amended by the 1972 Protocol, such as morphine and methadone; the 1971 United Nations Convention on Psychotropic Substances, such as diazepam and buprenorphine; and the 1988 United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, such as ergometrine and ephedrine. The conventions list substances in “Schedules” according to their different levels of potential for abuse and harm, and the commensurate severity of control measures to be applied by countries.
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The guideline on Drug misuse: opioid detoxification, commissioned by NICE and developed by the National Collaborating Centre for Mental Health, sets out clear, evidence-based recommendations for healthcare staff on how to work with people who misuse
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opioids to significantly improve their treatment and care, and to deliver detoxification safely and effectively. Of the estimated 4 million people in the UK who use illicit drugs each year, approximately 50,000 misuse opioids (such as heroin, opium, morphine, codeine and methadone). Opioid misuse presents a considerable health risk and can lead to significant social problems. This NICE guideline is an important tool in helping people to overcome their drug problem.
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The WHO Global Burden of Disease (GBD) study measures the burden of
disease using the disability-adjusted life year metric (DALY). The DALY metric
was developed to assess the burden of disease consistently across diseases,
risk factors and regions. A consistent and comparative description of the
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burden
of diseases and injuries and the risk factors that cause them is important as it
can inform health decision-making and health care planning.
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The Access to Controlled Medications Programme identified the development of treatment guidelines that cover the treatment of all types of pain as one of the core areas of focus for improving access to opioid analgesics. Such guidelines are interes
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ting both for health-care professionals and policy-makers. They are also important in improving access to controlled medicines for determining when those opioid medicines and when non-opioid medicines are preferred.
Based on a Delphi study, WHO planned the development of three treatment guidelines, covering chronic pain in children, chronic pain in adults and acute pain.
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The aims of these guidelines are to provide guidance to health-care providers (i.e. the end-users of these guidelines: physicians, nurses, pharmacists and caregivers) on the adequate relief of pain associated with cancer. They also assist policy-makers, programme managers and public health personnel
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to create and facilitate appropriately balanced policies on opioids and prescribing regulations for effective and safe cancer pain management. Proper and effective stewardship of opioid analgesics in the cancer treatment setting is essential to ensure the safety of patients and to reduce the risk of diversion of medicine into society.
The goal of cancer pain management is to relieve pain to a level that allows for an acceptable quality of life.
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The World Health Organization's fact sheet on opioid overdose highlights the significant global health issue posed by opioids, which include natural, semi-synthetic, and synthetic compounds used primarily for pain management. Misuse and unsupervised
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use can lead to dependence and severe health problems. In 2019, approximately 600,000 deaths were attributed to drug use, with nearly 80% related to opioids; about 25% of these were due to overdose. An opioid overdose is characterized by pinpoint pupils, unconsciousness, and breathing difficulties. The fact sheet emphasizes the importance of increasing access to naloxone, an opioid antagonist that can rapidly reverse overdose effects, and advocates for training individuals likely to witness an overdose in its administration. It also underscores the need for comprehensive strategies, including preventive measures, treatment for opioid dependence, and policies to reduce opioid availability.
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International Journal of Drug Policy 24 (2013) e91-98
Research Article
PLOS Medicine | https://doi.org/10.1371/journal.pmed.1002625 July 31, 2018 / 1-19
Science Spotlight
February 14, 2018
Regulation of the Minister of Health of the Republic of Indonesia concerning guidelines for implementation of opioid replacement therapy program
Prepared by NGOs: “Legalife-Ukraine”, “Insight”, “Positive Women”, and “Svitanok”
For the submission to the 66th CEDAW Session Geneva, Switzerland
13 February 2017 - 03 March 2017