Access to pain relief - World Hospice and Palliative Care Day

2. Length of supply allowed is short requiringrepeated journeys – which are potentiallyexpensive, a long way and difficult when ill– and repeated consultations with alreadybusy doctors.a. In Honduras only a three day supply of oralmorphine is dispensed.b. In Malawi only three days supply of analgesics aredispensed.c. Until the recent review of Romanian law, doctorscould only prescribe three days supply of morphine(for a small number of specified diseases specialauthorisation from a government consultant could beobtained for ‘long term prescribing’ allowing 10 – 15days supply on a repeated basis for threemonths). (20)d. In Israel, unless the doctor confirms that the patientlives far from a pharmacy, supply can only be givenfor 10 days at a time. Opioids are only available frompharmacies with Health Sick Insurance. In someareas there are few or no pharmacies with HealthSick Insurance, meaning patients have to travel along way for a few days supply. In addition, if any ofthe details required are omitted by mistake, thepharmacist will send the patient back to the doctor,which, when distances are far and patients’ are ill,can deter patients from obtaining their drugs.3. A maximum dose is stipulated. This doesnot account for patient variability and thefact that there is no maximum dose ofmorphine.a. Until reviewed recently, the Romania pharmacopeiastipulated that no more than 60mg per day should(20, 21)be prescribedb. Drug laws in Israel state that no more than 60mg perday can be prescribed for non-cancer patients(confirmation that patient has cancer needs to be onprescription).4. Lack of HCWs qualified to prescribecontrolled drugs.a. In Honduras, Tamil Nadu, Mongolia, Peru andKyrgyzstan only specialist palliative care and/oroncology doctors are allowed to prescribe morphine.b. In the Philippines only doctors with two speciallicences are able to prescribe morphine.c. Seventeen per cent of countries/regions werereported to require specific licences which were hardto obtain before being allowed to prescribemorphine.d. In Malawi (where clinical officers and doctors canprescribe opioids) there is only one doctor for every100,000 people. (22) Prior to a recent amendment,Ugandan laws allowed only doctors to prescribeopioids; in rural communities there is only onedoctor for 50,000 people. Therefore, most peopleare unable to access a doctor. These figurescompared to 164 doctors per 100,000 in the UK,where since May 2006 specialist nurses canprescribe opioids in addition to doctors.5. Lack of HCWs able to dispensecontrolled drugs.a. Ugandan law allows only pharmacists to dispenseoral morphine. In 2000 there were only 19pharmacists outside the capital (ie 19 pharmacists tocover a population of just over 21million). (23)b. In the Philippines only pharmacists with S3 licensesare allowed to dispense oral morphine.22