patients suffering from intolerable pain have a natural right to receive
medications to alleviate their suffering. But a the first-ever global survey by
the European Society for Medical Oncology – headed by an Israeli palliative
medicine specialist – has found that a “pandemic of untreated cancer pain”
caused by too strict regulation of pain medication has become a “scandal of
Called “groundbreaking and just published in Annals
of Oncology, the international collaborative survey of 22 partners shows that
more than half of the world’s population – four billion people – live in
developing countries where regulations aimed at stemming drug misuse leave
cancer patients without access to opioid medicines for managing cancer
“The GOPI study shows the developing world that it is
catastrophically difficult to provide basic medication to relieve strong cancer
pain,” says Prof. Nathan Cherny, a veteran oncologist and head of palliative
medicine at Jerusalem’s Shaare Zedek Medical center who is chairman of the ESMO
Palliative Care Working Group. “Most of the world’s population lacks the
necessary access to opioids for cancer pain management and palliative care, as
well as acute, post-operative, obstetric and chronic pain. When one
considers that effective treatments are cheap and available, untreated cancer
pain and its horrendous consequences for patients and their families is a
scandal of global proportions,” Cherny says.
The study, conducted in
Africa, Asia, Latin America, the Caribbean and the Middle East assessed the
availability of the seven opioid medications considered to be essential for the
relief of cancer pain by the WHO Model List of Essential Medicines and the
International Association for Hospice and Palliative Care.
essential medications include codeine, oral oxycodone, transdermal fentanyl,
immediate- and slow-release oral and injectable morphine, as well as oral
While there are problems with the supply of these medicines in
many countries, the main problem is over-regulation that makes it difficult for
healthcare professionals to prescribe and administer them for legitimate medical
use, the authors say.
“This is a tragedy born out of good intentions,”
says Cherny. “When opioids are over-regulated, the precautionary measures to
prevent abuse and diversion are excessive and impair the ability of healthcare
systems to relieve real suffering. The GOPI study has uncovered over-regulation
in much of the developing world.”
“The next step is for international and
local organisations working alongside governments and regulators to thoughtfully
address the problems,” adds study co-author James Cleary, Director of the Pain
and Policy Studies Group and Founding Director of the Palliative Medicine at the
UW Carbone Cancer Center, Madison, Wisconsin.
“Regulatory reform must be
partnered with education of healthcare providers in the safe and responsible use
of opioid medication, education of the public to de-stigmatize opioid analgesics
and improved infrastructure for supply and distribution,” he says.
ongoing initiatives to reform regulations, improve accessibility and promote the
education of clinicians and consumers in the effective use of opioid medications
for the relief of cancer pain will require vision, determination and the same
spirit of cooperation among organizations that made this study successful. The
challenges are great, but no greater than our resolution to the task of making
pain relief for cancer patients a reality irrespective of geography. Governments
should look at the GOPI survey data for their country and take concrete actions
to reduce the barriers,” Cherny concludes.
PANAMA ADOPTS UNITED HATZALAH
Panama has quietly been part of a non-military revolution – one that
involves emergency medical services – with help from a voluntary Israeli
organization. Frustrated by traffic and road conditions that often lead to
ambulance response times of 15 to 30 minutes or more, Panamanians Ramon Gateno
and Isaac Serfaty were looking for a better solution. Familiar with Israel’s
creative and often audacious solutions to technical problems, they began to do
some research in Israel. They were intrigued by the emergency medicine solutions
provided by the rescue and firstaid organization United Hatzalah and wondered if
it would work in Panama.
After months of planning, training and testing
United Hatzalah of Panama was launched.
Soon the orange-vest-clad
volunteers, such a common sight here, began to appear on the scene of
emergencies in Panama. As the group began to grow and the scope of the
emergencies that they were exposed to, began to expand they realized that they
needed to “up their game” to the next level. Ramon, Isaac and an elite group of
leading medics flew back to Israel to enhance their knowledge base and test
their mettle against the most rigorous training scenarios. The crash course was
a combination of intense classroom study by the finest UH instructors coupled
with real-life exposure through “shotgun” ride-alongs with the organization’s
ambucycles and ambulances. The course also provided the team with training and
exposure to the broadest and most intense forms of medical response in Israel.
They observed the practice of combat medicine at the Israel Defense Forces’
elite medical training base. They entered the hyper-realistic computerized
combat simulation center.
The flashes of simulated explosions merged with
the ear-splitting sounds of a combat soundtrack. Smoke, cries of the wounded and
simulated blood combined to create an unsettlingly intense environment to
attempt to save lives. The afterevent briefing was almost as brutal as the
UH’s medical director, the Hadassah University Medical
Center level 1 trauma unit head Prof. Avi Rivkind, has spearheaded many advances
in trauma treatment. It was here that the team from United Hatzalah of Panama
learned about the critical triage system utilized at Hadassah that separates the
ambulatory from those going to ER, surgery or the trauma unit.
and president Eli Beer told the Panamanians: “You must take the lessons learned
here back to your country and not only use it to save more lives but use it to
teach and inspire others to save more lives.” The UH model is expected to spread
further to other South American countries and beyond.