Cohort III International Pain Policy Fellows

1. Cohort IIIInternational Pain Policy Fellows Opioid Availability Action Planning Worksheet Madison, Wisconsin, USA 6 – 10 August 2012

2. Action Plan - Sri Lanka Dr.Suraj Perera Dr. N. Jeyakumaran 10 August 2012

3. Provinces (9) & Districts(25) of Sri Lanka

4. Sri Lanka Nine Provinces. Nine Cancer Units

5. Types of Hospitals • Teaching Hospitals • Provincial General Hospitals • District General hospitals • Base Hospitals • Divisional Hospitals. • Central Dispensaries.

6. National Cancer Control Programme, Sri Lanka National Advisory Committee on Cancer Control Minister of Health Secretary of Health Director General of Health Services (DGHS) Deputy Director General (DDG/ PHS 1) Director / National Cancer Control Programme * Consultant Community Physician

7. National Health Council Ministry of Health National Advisory Committee on Cancer Control Provincial Cancer Treatment Centres ( Kandy, Galle, Jaffna, Anuradhapura, Badulla, BatticaloaRatnapura, Kurunegala Other National level institutions ( FHB , Epidemiology Unit , D/NCD) National Cancer Control Programme (NCCP ) National Cancer Institute (Maharagama) Provincial Ministries of Health Provincial Committees of Cancer Prevention & Control ( PDHS, RDHS,Line Ministry Health Institutions of the district., Consultant Oncologist at provincial cancer treatment centres , Curative & Preventive health sectors ) District Committees of Cancer Prevention & Control Technical working Groups 1. Cervical / Breast Cancer Prevention 2. Oral Cancer prevention 2. Diagnosis & Cancer Therapy 3. Palliative care 4. Cancer surveillance 5. Cancer research

8. IssueInadequate Patient access to Opioid Analgesics

10. Problems • Less Priority given to Palliative Care • Limitations of existing law related to Opioids prescription • Inconsistencies on Distribution & Availability of Opioids at the point of delivery • Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting

11. Problem 1: Less Priority given to Palliative Care • Underlying reasons for the problem . • Multiple health issues with communicable & non communicable diseases. • About 15,000 to 20, 000 new cancer cases / year. • Most of the cancers are detected in late stages. • Palliative care is given a less priority. • Some aspects of palliative care. • In Cancer treatment centres. • In four hospices. • With few facilities. • minimum human resources.

12. Problem 1 : Less Priority given to Palliative Care

13. Problem 1 : (Cont…)Less priority given to Palliative Care

14. Problem 1 : (Cont…)Less priority given to Palliative Care

17. Guest Lecture : Palliative Care

19. Symposium on Palliative Care – 2010

20. Symposium on Palliative Care – 2010

21. Problem 2 :Limitations of existing law related to Opioids prescription Underlying reasons for the problem Deficiencies of POISONS,OPIUM, AND DANGEROUS DRUGS ordinance & its Amendments Under section 56 (1) • “A medical practitioner may administer, prescribe or supply any dangerous drug for the treatment of his patients, but shall not supply to any patient more than the amount to be taken by him during three days.” Under section 59 (2c) • “The total amount of the drug prescribed shall not exceed the amount to be taken by the patient during three days: Provided that the prescription may direct that the amount prescribed may be supplied on more than one but not more than three occasions at intervals to be specified in the prescription”

22. Problem 2 : Limitations of existing law related to Opioids prescription

23. Problem 3: Inconsistencies related to the distribution & availability of opioids at the point of delivery • Reasons for the problem.. • In Sri Lanka, palliative care and pain management is mainly offered at cancer units. • There is a varying level of availability of drugs and practice of dispensing analgesics including opioids. • Supply of Morphine: from one week to a month. • An availability of minimal pain management without access to Oral Morphine in the District General and BaseHospital.

24. Problem 3: Inconsistencies on Distribution & Availability of Opioids at the point of delivery

25. Problem 3: (Cont…)Inconsistencies on Distribution & Availability of Opioids at the point of delivery

26. Problem 3: (Cont…)Inconsistencies on Distribution & Availability of Opioids at the point of delivery

27. Problem 3: (Cont…)Inconsistencies on Distribution & Availability of Opioids at the point of delivery

28. Problem 3: (Cont…)Inconsistencies on Distribution & Availability of Opioids at the point of delivery

29. Problem 4: Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting. • Reasons for the problem.. • In Sri Lanka Health Care Professionals have varying levels of Knowledge, Attitudes and Practice towards Pain Management in general and opioid prescription in particular. • Imposes barriers to receive opioids for pain management.

30. Problem 4: (Cont…)Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting

31. Problem 4: (Cont…)Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting

32. Problem 4: (Cont…)Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting

33. Problem 4: (Cont…)Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting

34. Problem 4: (Cont…)Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting

35. Time Line of Activities

36. Time Line of Activities (cont..)

37. Goal : Opioid analgesics are available to the patients who need them. Quality of life of patients and families are improved.

40. Thank You