Presentation is loading. Please wait.

Presentation is loading. Please wait.

Improving Access to Controlled Medicines for Pain Management and Other Purposes Technical Briefing Seminar 4 November 2011 Geneva, Switzerland Willem Scholten,

Published byReynard Davidson Modified over 9 years ago

Similar presentations

Presentation on theme: "Improving Access to Controlled Medicines for Pain Management and Other Purposes Technical Briefing Seminar 4 November 2011 Geneva, Switzerland Willem Scholten,"— Presentation transcript:

1 Improving Access to Controlled Medicines for Pain Management and Other Purposes Technical Briefing Seminar 4 November 2011 Geneva, Switzerland Willem Scholten, Team Leader, Access to Controlled Medicines World Health Organization

2 Improving Access to Controlled Medicines | Geneva 4 November 2011 2 |2 | International Drug Control Conventions Single Convention on Narcotic Drugs (1961) United Nations Convention on Psychotropic Substances (1971) United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988)

3 Improving Access to Controlled Medicines | Geneva 4 November 2011 3 |3 | WHO Roles in Drug Control Advisory function to the UN system –Substance evaluation –Commission on Narcotic Drugs Improving access to controlled medicines –Century of drug control –Resolutions by WHA, ECOSOC and CND

4 Improving Access to Controlled Medicines | Geneva 4 November 2011 4 |4 | Controlled medicines on the WHO EML – Opioid analgesics: Morphine moderate to severe pain – Long-acting opioid agonists: methadone, buprenorphine treatment of opioid dependence – Ergometrine and ephedrine emergency obstetrics – Benzodiazepines anxiolytics, hypnotics, antiepileptics – Phenobarbital antiepileptic

5 Improving Access to Controlled Medicines | Geneva 4 November 2011 5 |5 | Conventions' Objectives 1961 and 1971 Conventions: Two goals: ● Prevention of harm from drug dependence ● Availability for rational medical use

6 Improving Access to Controlled Medicines | Geneva 4 November 2011 6 |6 | Adequacy Consumption of Opioid Analgesics (2007) Source: Seya MJ et al, J Pain & Pall Care Pharmacother 2011;25:6-18

7 Improving Access to Controlled Medicines | Geneva 4 November 2011 7 |7 | Adequacy of opioid consumption ( x million people)* WorldWPROSEAROEUROEMROAMROAFRO 4640012903350Adequate 252250228000Moderate 2551280127000Low 45779094772061Very low 4718151172283400304503No cons. 433222266449270No data 658017631721887540895774Total * People living in countries where opioid consumption is …

8 Improving Access to Controlled Medicines | Geneva 4 November 2011 8 |8 | Adequacy of Consumption Measure (ACM) ≥1 Adequate 0.3 – 1 Moderate 0.1 – 0.3 Low 0.03 – 0.1 Very Low < 0.03 No consumption

9 Improving Access to Controlled Medicines | Geneva 4 November 2011 9 |9 | ACM for countries present at TBS (1) ACM (2006)Required increase Annual need Afghanistan0 2007 ∾ 6,065 kg Angola0 ∾ 5,342 kg Cambodja0.0002 2007 5000 x Cameroon0 2007 ∾ 7,500 kg France0.818722% India0.00081250 x Jordan0.058117 x Nigeria0 2007 ∾ 48,500 kg

10 Improving Access to Controlled Medicines | Geneva 4 November 2011 10 | ACM for countries present at TBS (2) ACM (2006)Required increase Pakistan0.0005 2000 x Philippines0.0035 286 x Portugal0.36422.7 x Sierra Leone0.00005 2007 20,000 x Sudan0.0013769 x Switzerland1.4337- United Kingdom0.537686 % Zambia0.000110,000 x

11 Improving Access to Controlled Medicines | Geneva 4 November 2011 11 | ACM for top-10 HDI ACM (2006) 0.86Norway 0.88Australia 0.51Netherlands 2.47United States 0.41New Zealand 2.56Canada 0.51Ireland UnknownLiechtenstein 2.07Germany 1.06Sweden HDI top-10 for 2011

12 Improving Access to Controlled Medicines | Geneva 4 November 2011 12 | Adequacy as a function of Development Data for 2006

13 Improving Access to Controlled Medicines | Geneva 4 November 2011 13 | Patients affected (global figures, annually) Cancer pain patients untreated5.4 million HIV pain patients untreated1 million Lethal injuries Surgery 0.8 million 8-40 million Preventable HIV infections130,000 Mortality from post-partal haemorrhage 75,000

14 Improving Access to Controlled Medicines | Geneva 4 November 2011 14 | Adequacy of Consumption Measure Based on Morbidity Consumption of all strong opioids except methadone Benchmark: average of Top-20 countries in Human Develop Index Method for calculating long term needs  Long term targets for countries Seya MJ et al, J Pain and Pall Care Pharmacother, 2011;25:6-18

15 Improving Access to Controlled Medicines | Geneva 4 November 2011 15 | Reasons for low access to controlled medicines Excessive fear for dependence Excessive fear for diversion Neglected medical needs

16 Improving Access to Controlled Medicines | Geneva 4 November 2011 16 | Categories of Barriers Legislation and Policy Knowledge Attitudes –Health-Care Professionals –General Public Economic

17 Improving Access to Controlled Medicines | Geneva 4 November 2011 17 | WHO Access to Controlled Medicines Programme To assist countries in improving access through: Development of tools (e.g. guidelines and manuals) Analysis of policy and legislation Country assistance

18 Improving Access to Controlled Medicines | Geneva 4 November 2011 18 | WHO Policy Guidelines (1) 15 languages including Russian, Polish and English On-line: free (15 languages) http://www.who.int/medicines/areas/quality_s afety/guide_nocp_sanend/en/index.html In print: US$ 25.– (English and French only) Ensuring Balance in National Policies on Controlled Substances, Guidance for accessibility and availability of controlled medicines (Geneva 2011)

19 Improving Access to Controlled Medicines | Geneva 4 November 2011 19 | WHO Policy Guidelines (2) Based on Principle of Balance: Obligation of governments to establish a system of drug control that – ensures the adequate availability of controlled substances for medical and scientific purposes – while simultaneously preventing abuse, diversion and trafficking 21 Guidelines and Country Check List

20 Improving Access to Controlled Medicines | Geneva 4 November 2011 20 | 21 Guidelines Topics Content of drug control legislation and policy (2 recommendations) Authorities and their role in the system (4 recommendations) Policy planning for availability and accessibility (4 recommendations) Healthcare professionals (4 recommendations) Estimates and statistics (3 recommendations) Procurement (3 recommendations) Other (1 recommendation)

21 Improving Access to Controlled Medicines | Geneva 4 November 2011 21 | WHO Cancer Pain Guidelines (1) Cancer Pain (1st Ed: 1986, 2nd Ed: 1996) Cancer Pain and Palliative Care in Children (1998) Introduced Three Step Analgesic Ladder Systematic approach: –"By the ladder" –"By the clock" –"By the appropriate route" –"By the individual"

22 Improving Access to Controlled Medicines | Geneva 4 November 2011 22 | WHO Cancer Pain Guidelines (2) Still actual for the systematic approach: –"By the clock" –"By the appropriate route" –"By the individual" Obsolete now for some recommended opioids –E.g. levorphanol, pethidine Three step ladder / Two step approach? Not evidence-based / no transparency

23 Improving Access to Controlled Medicines | Geneva 4 November 2011 23 | Development of WHO Pain Guidelines To cover all various types of pain Developed by the Access to Controlled Medications Programme "Quality control" by WHO Guidelines Review Committee WHO "Guidelines for Guidelines" impose rigour: –Methodology –Evidence –Transparency –Quality control

24 Improving Access to Controlled Medicines | Geneva 4 November 2011 24 | New WHO Pain Guidelines 1. WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illness – Publication expected by early 2012 2. Pharmacological Treatment of Persisting Pain in Adults – Starting December 2011 3. Pharmacological Treatment of Acute Pain – Currently finalizing the Scoping Document

25 Improving Access to Controlled Medicines | Geneva 4 November 2011 25 | WHO Pediatric Persisting Pain Guidelines Selected elements of the Contents Classification of pain in children Evaluation of persisting pain in the paediatric population Pharmacological treatment strategies Improving access to pain relief in health systems Annex 1. Pharmacological profiles for selected medicines. Annex 5. Research agenda

26 Improving Access to Controlled Medicines | Geneva 4 November 2011 26 | Basic Principles Principles from the pediatric persisting pain guidelines: Comprehensive approach –non-opioid analgesics, opioid analgesics, adjuvants and non- pharmacological strategies Correct use of analgesic medicines will relieve pain in most children with persisting pain due to medical illness Key concepts: –using a two-step strategy –dosing at regular intervals ("by the clock") –using the appropriate route of administration ("by the mouth") –tailoring treatment to the individual child ("by the individual").

27 Improving Access to Controlled Medicines | Geneva 4 November 2011 27 | Recommendations 20 Clinical recommendations 4 Health system recommendations

28 Improving Access to Controlled Medicines | Geneva 4 November 2011 28 | Selected Recommendations Two Step Approach according to the child's level of pain severity. First step: paracetamol or ibuprofen (mild pain) –both to be made available Second step: morphine (moderate to severe pain)  Codeine is no longer recommended  Tramadol also not recommended

29 Improving Access to Controlled Medicines | Geneva 4 November 2011 29 | Furthermore… All moderate and severe pain in children should always be addressed.

30 Improving Access to Controlled Medicines | Geneva 4 November 2011 30 | Paediatric Persisting Pain Based on systematic reviews of scientific literature GRADE method Recommendations: scale Strong - Weak Evidence level: scale High - Very low

31 Improving Access to Controlled Medicines | Geneva 4 November 2011 31 | However… For most recommendations: –evidence levels assessed "low" and "very low" Several clinical questions could not be answered  Research agenda Published in: Evidence Based Child Health 6: 1017- 1020 (2011)

32 Improving Access to Controlled Medicines | Geneva 4 November 2011 32 | WHO Call for Research (1) Identified Research Gaps Clinical studies needed on paracetamol, NSAIDs and opioid analgesics –8 research topics Clinical studies needed on adjuvant medicines for neuropathic pain Pharmacokinetics Pain assessment tools

33 Improving Access to Controlled Medicines | Geneva 4 November 2011 33 | WHO Call for Research (2) Barbara Milani, Nicola Magrini, Andy Gray, Phil Wiffen and Willem Scholten WHO Calls for Targeted Research on the Pharmacological Treatment of Persisting Pain in children with Medical Illnesses Evid.-Based Child Health 6: 1017- 1020 (2011) www.evidence-basedchildhealth.com DOI: 10.1002/(ebch.777)

34 Improving Access to Controlled Medicines | Geneva 4 November 2011 34 | Publication of Ped Pain Guidelines Package containing: –Guidelines book –Brochure "Important information for physicians and nurses" –Brochure "Important information for pharmacists" –Brochure "Important information for policy makers" –Dosing card (pocket size) –2 Ped. pain assessment scales –Wall chart (waiting room) English version in print (US$ 25) and on-line (free) Translations subject to availability of funding and to national initiatives –Licences for national languages: permissions@who.int

35 Willem Scholten, PharmD, MPA Team Leader, Access to Controlled Medicines Essential Medicines and Pharmaceutical Policies World Health Organization Geneva, Switzerland scholtenw@who.int +41 22 79 15540 Improving Access to Controlled Medicines for Pain Management and Other Purposes

Download ppt "Improving Access to Controlled Medicines for Pain Management and Other Purposes Technical Briefing Seminar 4 November 2011 Geneva, Switzerland Willem Scholten,"

Similar presentations

February 2006 WHO's Contribution to Scaling Up towards Universal Access to HIV/AIDS Prevention, Care and Treatment 2006-2010 Department of HIV/AIDS.

February 2006 WHO's Contribution to Scaling Up towards Universal Access to HIV/AIDS Prevention, Care and Treatment Department of HIV/AIDS.
Medication Management

Medication Management
Department of Medicines Policy and Standards The WHO Model List of Essential Medicines – Palliative Care update Suzanne Hill World Health Organisation.

Department of Medicines Policy and Standards The WHO Model List of Essential Medicines – Palliative Care update Suzanne Hill World Health Organisation.
Part A/Module A1/Session 4 Part A: Module A1 Session 4 Comprehensive Care for People Living with HIV/AIDS (PLHA)

Part A/Module A1/Session 4 Part A: Module A1 Session 4 Comprehensive Care for People Living with HIV/AIDS (PLHA)
Vienna, Austria 4 September 2014 Stefano Berterame, Chief Narcotics Control and Estimates Section Secretariat of the International Narcotics Control Board.

Vienna, Austria 4 September 2014 Stefano Berterame, Chief Narcotics Control and Estimates Section Secretariat of the International Narcotics Control Board.
Human Rights and Palliative Care: A Primer Kiera Hepford Open Society Foundations Costing for Change Seminar Brasov, Romania October 26 th - 28 th, 2011.

Human Rights and Palliative Care: A Primer Kiera Hepford Open Society Foundations Costing for Change Seminar Brasov, Romania October 26 th - 28 th, 2011.
Introduction to Treat the Pain. The problem of unrelieved pain Globally, 7.3 million people die of cancer or HIV each year in moderate or severe pain.

Introduction to Treat the Pain. The problem of unrelieved pain Globally, 7.3 million people die of cancer or HIV each year in moderate or severe pain.
PSK Annual Conference 2008 Palliative care medicine: A balanced approach to opioid availability and safe use in Kenya Presenter: Dr. Bilha Kiama-Murage.

PSK Annual Conference 2008 Palliative care medicine: A balanced approach to opioid availability and safe use in Kenya Presenter: Dr. Bilha Kiama-Murage.
Palliative Care – update for the acute physician 03.04.2014 Dr Anne Goggin.

Palliative Care – update for the acute physician Dr Anne Goggin.
International Experience in Pharmaceutical Services for Promoting Access to Medicines: Canada, Cuba, England, Mexico International Seminar on the Challenges.

International Experience in Pharmaceutical Services for Promoting Access to Medicines: Canada, Cuba, England, Mexico International Seminar on the Challenges.
Systematic Reviews and the American Academy of Pediatrics Virginia A. Moyer, MD, MPH Professor of Pediatrics Baylor College of Medicine.

Systematic Reviews and the American Academy of Pediatrics Virginia A. Moyer, MD, MPH Professor of Pediatrics Baylor College of Medicine.
You can control pain Module 9. Learning objectives ■ Describe the 3 steps of the analgesic ladder ■ Give examples of drugs from each step of the ladder.

You can control pain Module 9. Learning objectives ■ Describe the 3 steps of the analgesic ladder ■ Give examples of drugs from each step of the ladder.
Access to Controlled Medicines Willem Scholten, PharmD, MPA Team Leader, Access to Controlled Medicines, World Health Organization, Geneva, Switzerland.

Access to Controlled Medicines Willem Scholten, PharmD, MPA Team Leader, Access to Controlled Medicines, World Health Organization, Geneva, Switzerland.
Access to Controlled Medicines Willem Scholten, Team Leader, Access to Controlled Medicines, Department of Essential Medicines and Pharmaceutical Policies.

Access to Controlled Medicines Willem Scholten, Team Leader, Access to Controlled Medicines, Department of Essential Medicines and Pharmaceutical Policies.
Dr Fabienne Hariga Senior Adviser UNODC HIV Section, Vienna 27 May 2014 Mandates, missions, roles and responsibilities & relation to health in prisons.

Dr Fabienne Hariga Senior Adviser UNODC HIV Section, Vienna 27 May 2014 Mandates, missions, roles and responsibilities & relation to health in prisons.
Pethidine: Gap Between Evidence and Practice Professor Richard Day Dept of Clinical Pharmacology and Toxicology St Vincent’s Hospital, Sydney Prepared.

Pethidine: Gap Between Evidence and Practice Professor Richard Day Dept of Clinical Pharmacology and Toxicology St Vincent’s Hospital, Sydney Prepared.
Critical Appraisal of Clinical Practice Guidelines

Critical Appraisal of Clinical Practice Guidelines
Procedure for narcotic drugs use for medical purposes in the Republic of Kazakhstan.

Procedure for narcotic drugs use for medical purposes in the Republic of Kazakhstan.
Whilst the pharmaceutical industry plays a key role in developing and producing medicines, there is a tension between industry’s need to expand product.

Whilst the pharmaceutical industry plays a key role in developing and producing medicines, there is a tension between industry’s need to expand product.
The Organizational Structure Of The European Paediatric Emergency Department: A Descriptive Pilot Study Mintegi S *, Shavit I **, Benito J * * Cruces Hospital.

The Organizational Structure Of The European Paediatric Emergency Department: A Descriptive Pilot Study Mintegi S *, Shavit I **, Benito J * * Cruces Hospital.

Similar presentations

Ads by Google