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THAILAND: Report on Opioid Availability

OPIOID ACCESSIBILITY WORKSHOP. Boracay Island, Philippines, 19-21 April 2008. THAILAND: Report on Opioid Availability. The Reality. In Thailand, consumption of opioid analgesics remains extremely low in comparison to medical need, compare to many Asian countries.

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THAILAND: Report on Opioid Availability

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  1. OPIOID ACCESSIBILITY WORKSHOP Boracay Island, Philippines, 19-21 April 2008 THAILAND: Report on Opioid Availability

  2. The Reality • In Thailand, consumption of opioid analgesics remains extremely low in comparison to medical need, compare to many Asian countries. Average daily consumption of defined daily doses of morphine per million inhabitants, 2003-2005: countries of Central, South and East Asia THAILAND

  3. Barrier to Pain Relief 1. Social Culture Values (i.e. Fear of addicts, reluctance to report pain) 2. Healthcare System (i.e. Lack of training and Fear of legal consequence) • OPIOPHOBIA =failure to legimate opioid analgesics because of a fear of power of this drug to produce addiction 3. Economic 4. Drug Regulation (i.e. Government Policy-limit the quantity and duration of opioid prescription, National health priorities may not include cancer pain relief)

  4. Classification of Medicines for Pain Relief • Mild – ASA, Acetaminophen, NSAIDS, Antidepressant drugs • Moderate – Codeine, Hydrocodone, Oxycodone, Dihydrocodeine, Tramadol • Severe – Morphine, Hydromorphone, Methadone, Levorphanol, Fentanyl, Oxycodone

  5. Classification of Medicines for Pain Relief (cont.) • Short-acting (3-4 hours): Morphine sulfate, Codeine, Hydrocodone, Oxycodone, Hydromorphone, Oxymorphone • Pharmacologically long acting (6-8 hours): Methadone, Levophanol • Pharmaceutically long acting (12-24, 72 hours) Morphine SR, Oxycodone SR, Fentanyl transdermal patches

  6. Narcotic drugs in Thailand • Morphine • Pethidine • Fentanyl • Methadone • Codeine

  7. 1. Morphine For Oral form 2 Preperations Injection form 1. Morphine sulfate 10 mg Inj (With Preservative) 2. Morphine sulfate 10 mg Inj (Preservative Free) 06/08/57

  8. Morphine (2) For Oral form 1. Sustained release capsule (Kapanol®) : 3 strengths20 mg,50 mg และ 100 mg 2. Continous Tablet(MST Continous Tablet) : 3 strengths10 mg,30 mg และ 60 mg 06/08/57

  9. 2.Pethidine Preperation Injection form Pethidine HCL 50 mg/ml Inj (1 ml) 06/08/57

  10. 3. Fentanyl TTS form(Transdermal Therapeutic System) Preperation Injetion form Fentanyl citrate Inj 2 ml Fentanyl citrate Inj 10 ml 06/08/57

  11. Fentanyl (2) TTS form(Transdermal Therapeutic System) : 3 strengths Fentanyl TTS 12 mcg/hour * Fentanyl TTS 25 mcg/hour Fentanyl TTS 50 mcg/hour • Fentanyl TTS 12 mcg/hour : first import in Thailand • at June 1997 06/08/57

  12. 4. Methadone For Oral form 1. Methadone HCL 5 mg/tab (Pain release not use to treat addicts) 2. Methadone HCL Oral Solution 10 mg/ml (For medical institutes of treating addicts) 06/08/57

  13. 5. Codeine Preperation 1. Single formula N 2 Codeine PO415mg Codeine PO430mg 2. As ingredients in medicinal formula Anti-tussive ,Analgesic N 3 06/08/57

  14. Trends of Consumptions

  15. Graph 1 COMPARE TOTAL QUANTITY OF MORPHINE BETWEEN LIMIT AND CONSUMPTION (2001-2006) Kg.base year

  16. Graph 2TRENDS OF CONSUMPTION FOR ORAL MORPHINE ( 2003-2007) Capsule/tablet Year 2003 2004 2005 2006 2007

  17. Graph 3 TRENDS OF CONSUMPTION FOR INJECTION MORPHINE ( 2003-2007) Ampule 2003 2004 2005 2006 2007 Year

  18. Graph 4 COMPARE TOTAL QUANTITY OF PETHIDINE BETWEEN LIMIT AND CONSUMPTION (2001-2006) Kg.base year

  19. Graph 5 TRENDS OF CONSUMPTION FOR PETHIDINE(2003-2007) Ampule Year 2003 2004 2005 2006 2007

  20. Graph 6 COMPARE TOTAL QUANTITY OF FENTANYL BETWEEN LIMIT AND CONSUMPTION (2001-2006) Kg.base year

  21. Graph 7TRENDS OF CONSUMPTION FOR FENTANYLINJ.(2003-2007) Ampule year

  22. Graph 8TRENDS OF CONSUMPTION FOR FENTANYLTTS(2003-2007) Piece year

  23. Graph 8 COMPARE TOTAL QUANTITY OF METHADONE BETWEEN LIMIT AND CONSUMPTION (2001-2006) Kg.base year

  24. Graph 9TRENDS OF CONSUMPTION FOR METHADONE(2003-2007) gm year

  25. Graph 10 COMPARE TOTAL QUANTITY OF CODEINE BETWEEN LIMIT AND CONSUMPTION (2001-2006) Kg.base year

  26. Increase Opioids Accessibility 1. Amendment the regulation and solve the obstacle of narcotic analgesics purchasing and availability. 2. Recommended opioid analgesic by WHO is included in National Essential Drug List. 3. Analgesics and opioid analgesics in National Essential Drug List are available in pharmacy of every General hospital. 4. Thai FDA produces and distributes opioid analgesics especially oral opioid in Thailand. 5. Provide narcotic quota for each form and strength of narcotic analgesics separately eg. oral, solution, patch, and injection

  27. Problem about Opioids Accessibility in Thailand Prob 1. Physician education and attitudes Action Plan • Apply pain and palliative care into curriculum (both undergraduate and postgraduate students ) to cover pain, palliative care and professionalism • Continuing pharmaceutical and nurse education • Mobile advocating unit to educate in whole country

  28. Problem about Opioids Accessibility in Thailand Prob 2. Accessibility, availability and affordability of opioid formulations (National Insurance Institute) Action Plan • Meeting up with GPO board committee about available morphine formulation • Meeting with National Health Insurance Institute for the subsiding policy

  29. Problem on Opioids Accessibility in Thailand Prob 3. Pediatric cancer pain is undertreated Action Plan • More research projects on pediatric need assessment • Encourage task force to deal with pediatric palliative care • Availability of pediatric formula for pediatric (dosage form and formula i.e. Morphine oral solution 10mg/5ml, 5mg/5ml) • Special hospital for children

  30. Problem on Opioids Accessibility in Indonesia & Philippines • Pain management for cancer and HIV/AIDS are low priorities (i.e. Indonesia) • Not all of hospital and pharmacy have a stock of opioids • Shortage of opioid for cancer pain, HIV/AIDS • Physician license • Problem on education and information

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