Treat the Pain: A Program to Address Supply and Demand Issues in Pain Relief Ambassador Sally Cowal Senior Vice President, Global Health American Cancer Society Millions suffer pain unnecessarily •  Low and middle-income countries •  71% of deaths from cancer •  99% of deaths from HIV •  Consume just 7% of medicinal opioids worldwide 2 Unnecessary suffering because morphine is: •  On the World Health Organization essential medicines list •  Plentiful •  Inexpensive •  Effective for 80-90% of cancer patients •  Safe •  Easy to use in lower-resource settings 3 Solving the problem •  The problem can be viewed and addressed through several frameworks, including: –  Human rights –  Human resources –  Regulatory and policy •  We approach it with a mechanism of access framework that focuses on administrative and bureaucratic processes that govern access to medicines 4 Mechanism of access Mindset | Organize | Regula2ons | Procurement | Healthworker | Ini2a2on | Na2onaliza2on | Empowerment Ensure that policy Consult stakeholders to Establish budget for drug Organize awareness-‐raising Establish pain treatment Integrate into service delivery Create a sustainable makers understand map process and barriers up-‐to-‐date or iden2fy purchase, storage, and ac2vi2es, in-‐service training, by trained clinicians, at regional and district stakeholder base the issues and are to access distribu2on. Es2mate and con2nuing medical usually at large clinical hospitals and ensure adequate prepared to take a quan22es, iden2fy educa2on; develop reference centers or specialized geographical coverage to make lead role suppliers, secure product materials and pain relief accessible to all who registra2ons, develop tenders, Guidelines Ensure that they are needed changes clinical units need it place and pay for orders, and receive and distribute to regional medical stores •  Group and sequence interventions in eight categories •  Establish a supply of essential pain medicines in the public sector •  Train health care providers to use them •  Initiate treatment at large clinical centers •  Decentralize treatment to reach all patients in need 5 Key programs •  Technical assistance –  We provide technical consultants to add expertise and manpower to government •  Supply –  We work with government and suppliers to lower the price and improve availability of essential pain medicines •  Pain-free hospital initiative –  We work directly with national referral hospitals and cancer centers to train and motivate healthcare providers •  Programs in Kenya, Nigeria, Uganda, Ethiopia, and Swaziland 6 Progress in Uganda •  Creation of a national oral morphine production facility has doubled morphine consumption in Uganda •  Ugandan government now provides morphine to all patients at no cost •  Pain-Free Hospital Initiative will start at national cancer institute in 2015 7 Progress in Kenya •  Government has procured morphine for the first time in more than a decade •  Pain-Free Hospital Initiative is under way at the national referral hospital •  National oral morphine production facility to be started in 2015 8 Progress in Nigeria •  Government has procured morphine for the first time since 2010 •  Establishment of local production facilities at major teaching hospitals has reduced the price by ~85% •  Pain-Free Hospital Initiative will be launching in four teaching hospitals in 2015 9 Lessons learned •  Access to essential pain medicines remains extremely limited and causes needless suffering •  Simple, low-cost interventions can improve access to pain relief in a short amount of time •  This is a problem that can be solved Video 10