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Access to pain relief T&T 2012

Access to pain relief T&T 2012. Prepared by: K Capildeo Presenter: J Sabga. mg/capita. Global Consumption of Morphine, 2010. TT’s morphine use per capita: 75% below world average!. Global Mean 5.9912. T&T 1.54. 152 countries.

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Access to pain relief T&T 2012

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  1. Access to pain reliefT&T 2012 Prepared by: K Capildeo Presenter: J Sabga

  2. mg/capita Global Consumption of Morphine, 2010 TT’s morphine use per capita: 75% below world average! Global Mean 5.9912 T&T 1.54 152 countries **Austria’s consumption includes use of morphine for substitution therapy Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012

  3. Grams of morphine per capita versus gross national income. Nickerson JW, Attaran A (2012) The Inadequate Treatment of Pain: Collateral Damage from the War on Drugs. PLoS Med 9(1): e1001153. doi:10.1371/journal.pmed.1001153 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001153

  4. T&T: rankings • World bank: High income, non-OECD • Others include Bahamas, Barbados, Qatar, Singapore • GDP per capita (IMF 2010-11) • TT is at #42 • Taiwan #40, Slovakia #41, Barbados #44 • Human development index (UNDP) 2011: TT at #62 (high human development) • Others in group: Mexico #57, Panama #58 Malaysia #61, Kuwait #63, Russia #66

  5. So is cost really the issue? Can our opioid shortages, causes and and solutions, be equated with situation in poorest countries where absolute lack of funds is the limiting factor?

  6. Numerous drugs on MoH formulary costing >US$1000 per month

  7. Many costly procedures available in MoH service

  8. Drug availability Sept 2012National Radiotherapy Ctr, San Fernando, Sangre Grande

  9. Step 2 analgesics in tT • No access in public service to most step 2 drugs • No codeine, dihydrocodeine, combinations • Only one is Tramadol ± Acetaminophen • Often out of stock

  10. Step 3 analgesics • Frequent interruptions of supply especially morphine liquid and sometimes 30mg SR • Morphine SR 60mg not practical starting dose • Frequent use of Pethidine • Not optimal analgesic • BUT, need to conserve precious stocks of Morphine • Few options for patients intolerant to Morphine • If unable to take orally, few outpatient options • No fentanyl patches • No syringe drivers (nor system to monitor same)

  11. Can this distort practice? • Cocktails of Step 1 and Step 2 drugs ± Pethidine, even when Morphine is best option, to conserve Morphine stocks • Admission to acute ward for pain control if unable to take oral analgesics • Aggressive use of chemotherapy and radiotherapy in near-futile situations in hope of controlling cancer pain by controlling cancer

  12. Solutions?

  13. Acknowledgements • Dr. S. Chamely, San Fernando General Hospital • Mrs. A. Lochan, Sangre Grande Hospital • Mrs. K. Reid, National Radiotherapy Centre • Mr. K. Stephens, Sangre Grande Hospital

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