A Blueprint for Reforming Access to Opioid Medications: Entry Points for International Action to Remove the Policy Barriers to Care and Treatment

Abstract

Opioids medicines are the standard of care for treating severe pain. Drugs like methadone and buprenorphine have proven effective in treating dependency on heroin and other opiods. Access to therapeutic opioids is not only medically appropriate - it is the law. The world's drug control treaties recognize that opioid medicines are "indispensable" to proper medical care, and require signatories to take measures to adequately provide for their effective medical use.

In spite of all the reasons that access to therapeutic opioids should be routine everywhere, there remains a huge unmet need and a striking global inequality in access. The WHO has estimated that 80% of the world's cancer patients and half of all people with AIDS suffer untreated severe pain. Millions of injection drug users and illicit opioid users are forced to go without methadone treatment because the opioids needed for care are either overly regulated or under-provided.

The purpose of this report, funded by the U.K. Department for International Development, is to capture what can be learned from past reform efforts, and to set out practical interventions that can help nations at any stage of readiness. Its primary audience is those who fund, advocate for or facilitate policy reform through technical assistance and training. The Blueprint begins with a discussion of the guiding principles of balance and sustainability. It then sets out a strategy for investment in opiod access reform built around an understanding of the cycle of policy learning and identifies tactics for advancing reform that were effective in the countries whose experience we examined.

Keywords: pain, palliative care, drug treatment, medication-assisted therapy, morphine