Overviews of the Drug Distribution System & Barriers to Opioid

Availability

Dr. Bishnu Dutta Paudel

International Pain Policy Fellowship

Training ProgramMadison, Wisconsin, USA

6 August 2012

GLOBAL DISPARITIES

• In 2010, eight countries together accounted for 85% of global consumption of morphine.

Why is opioid use so low?INCB Survey of government drug control authorities 1995(65

countries) & 2007( 144 countries)

By: University of Wisconsin Pain & Policy Studies Group/WHO Collaborating Center, 2008

International Narcotics Control Board. (1996). Report of the International Narcotics Control Board for 1995: Availability of Opiates for Medical Needs. New York, NY: United Nations.

Why is opioid use so low?

Barriers to opioid availability:

1) Fear of addiction

2) Lack of training health care providers

3) Excessively restrictive laws and regulations

4) Fear of legal consequences

Why is opioid use so low?

5) Insufficient supply of opioids

6) Cost of opioids

7)Inadequate health care resources

8) Lack of national policy, guidelines

Why is opioid use so low?

2006 Survey of Health care workers, and hospice/PC staff in Asia, Africa and Latin America

By: University of Wisconsin Pain & Policy Studies Group/WHO Collaborating Center, 2008

Adams, V. (2007). Access to Pain Relief – an essential human right. Help the Hospices, Worldwide Palliative Care Alliance.

Why is opioid use so low?

Barriers to accessing oral morphine:

1) Excessively strict national drug laws and regulations;

2) Fear of addiction;3) Poorly developed health care systems;4) Lack of knowledge

Barriers to opioid availability

1) Opioid Regulatory Policy

2) Drug Distribution System

3) Cost of Opioid Analgesics

4) Knowledge & Attitudes

DRUG DISTRIBUTION SYSTEM

The entire system of medication procurement and distribution for health care.

Op

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An

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Info

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Level 1: International Narcotics Control Board

Level 4: Hospitals / Pharmacies / Hospice/ PC facilities

Level 6: PATIENTS

Level 2: National Competent Authority

Level 3: Importers / Manufacturers / Distributors

Level 5: Physicians / Pharmacists / Nurses

DRUG DISTRIBUTION SYSTEM BARRIERS

Government has not made procurement arrangements for importation or domestic manufacture of opioids

Delays in government decision-making

Inadequate methods for assessing medical needs

DRUG DISTRIBUTION SYSTEM BARRIERS

Pharmacies that stock opioid medications are inadequate in number, in geographical location (rural areas), and/or hours of operation

No system to ensure the safe transport of medications from wholesale level to retail level

LACK OF DEMAND / Not ordered within country

COST OF OPIOID ANALGESICS

-More expensive opioid analgesics available

- No reimbursement for pain management or palliative care in national policies

COST OF OPIOID ANALGESICS

Lack of low-cost / generic oral opioid analgesics (powder to make into tablets or solution)

CONCLUSIONS

Barriers to opioid availability and patient access can be found at different levels:

1) Opioid Regulatory Policy2) Drug Distribution System3) Cost of Opioid Analgesics4) Knowledge & Attitudes

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CONCLUSIONS

• Barriers must be identified and addressed in order to improve opioid availability to achieve pain relief.

• The International Pain Policy Fellowship is designed to assist with this process.

• Consider the barriers in your country before working on your Action Plans.

THANK YOU !