Closing the Gap: Case Studies of Opioid Access Reform in China, India, Romania & Vietnam

Abstract

Millions of people with cancer, HIV/AIDS and other conditions do not receive the opiod analgesics that would relieve their pain. Millions of others, dependent on illicit opiods, have no access to medication-assisted therapy with methadone or buprenorphine, which has been shown to be effective in treating dependence - and in reducing the risks of HIV infection. There are many reasons for this unfortunate and paradoxical state of affairs, but policy is a crucial factor. In countries throughout the world, drug control policies and outmoded ideas have helped perpetuate negative attitudes about opioids, prevented health care professionals from getting experience in their use, and erected often insurmountable regulatory barriers to their availability. Yet there are numerous stories of successful reduction in policy barriers. With help from the international community, many countries have succeeded in striking a better balance in their drug control laws between law enforcement and good medicine. This report, funded by the U.K. Department for International Development, describes the reform process in four countries - China, India, Romania and Vietnam - highlighting the tactics that international donors, UN agencies and technical experts used to support policy reform.

Keywords: pain, palliative care, drug treatment, morphine, policy