opioids and palliative care on the who eml(c) · 1 opioids and palliative care on the who eml(c) |...
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 20131
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
Opioids and Palliative Care on the WHO EML(c)
19th Expert Committee on the Selection and Use of Essential Medicines
Willem Scholten, PharmD, M.P.A.Consultant – Medicines and Controlled Substances
Nyon, Switzerland
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 20132
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
About myself
• Pharmacist; Master in Public Administration• Former Team Leader, Access to ControlledMedicines in the WHO Dept. of Essential Medicines and Pharmaceutical Policies (2005‐2012)
• Developed WHO Pediatric Pain Guidelines and Policy Guidelines on controlled medicines
• Many publications on access issues
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 20133
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
ADDITION OF OPIOID PREPARATIONSand
POSITIONING OF PALLIATIVE CAREMorphineOxycodoneHydrocodone
Palliative Care Medicines at Highest Level Section
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 20134
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
From: Duthey B and Scholten W ; unpublished data.
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 20135
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
15 Com
posite level Courtesy Lynch T, Connor S and Clark D
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 20136
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
WHO Policy GuidelinesEnsuring Balance in National Policies on Controlled Substances, Guidance
for accessibility and availability of controlled medicines (Geneva 2011)
http://www.who.int/medicines/areas/quality_safety/guide_nocp_sanend/en/index.html
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 20137
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
Guideline 7 (Recommendation text)
Governments should include the availability and accessibility of controlled medicines for allrelevant medical uses in their national pharmaceutical policy plans. […]
(bold‐underlined by WS)
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 20138
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
Guideline 7 (From explanation)
• Planning for availability through the formulation of policy plans is essential for defining and realizing the health policy objectives of a country.
• Only after establishing this general [pharmaceutical –WS] policy should specific policy plans be developed for individual diseases.
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 20139
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
WHO Persisting Pain in ChildrenPackage
http://www.who.int/medicines/areas/quality_safety/guide_on_pain/en/index.html
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 201310
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
Pead. Treatment Guidelines
• Morphine recommended as 1st choice opioid• Two alternative opioids to be available
• Children’s pain should always be addressed• This will usually require opioids in case of moderate and severe pain All pain – NOT cancer pain only
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 201311
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
Pain in adults
Need for morphine and alternative opioids:• Equally true• No formal WHO pain treatment GLs ready(scoping document approved by GRC)
• Evidence from WHO Cervical cancer guidelines (in preparation)
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 201312
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
Conclusion (I)
Important messages to be given by WHO (I)
• Availability of morphine and two alternative opioids is an essential requirement for adequate treatment of pain in children
– To consider: to extend this to adults
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Opioids and Palliative Care on the WHO EML(c) | Geneva – 8 April 201313
Willem Scholten PharmD MPAConsultant – Medicines and Controlled Substances
Conclusion (II)
Important message to be given by WHO (II)
• Palliative Care is for a wide area of diseases– Not: cancer only!– Application to move PC section to the highestlevel in EMLc and to extend this to the EML