Barriers to opioid use in developing countries identified
There is a lack of use of opioids for pain management in many developing countries mainly due to unfounded prejudices and barriers, according to a presentation at the 7th Association of South-East Asian Pain Societies Congress (ASEAPS 2017) held in Yangon, Myanmar.
“There is a big discrepancy in [opioid use] between developed and developing countries,” said Dr Husni Tanra from the Faculty of Medicine, Hasanuddin University in Makassar, Indonesia. It appears that the more developed the country, the higher the opioid use. Despite the benefits and safety of opioids in pain treatment, opioids are still underused in developing countries, he said.
“There are at least four barriers to using opioids in clinical practice in developing countries,” said Tanra. These are patient, drugs/government, physician, and education barriers.
For a pain management programme to succeed, ie, for patients to acquire good pain management, there are three factors that need to be met – drug availability, education, and institutional policy.
Due to cultural or religious beliefs, some patients believe that pain is inevitable, particularly after surgery, said Tanra. Others feel that if they begin taking opioids too early, the drugs will lose their effect. Some patients may also be of the opinion that opioids are only for patients who are dying, while others fear addiction.
Another barrier is the availability, accessibility, and affordability of opioids in developing countries. Using Indonesia as an example, Tanra stated that the more expensive opioids (eg, slow-release morphine) are more easily available than the more affordable ones (rapid-release morphine).
Inadequate knowledge or prejudices by physicians is yet another barrier to opioid use. One such prejudice, said Tanra, is that when it comes to opioids, many physicians focus on the side effects such as addiction and sedation instead of the potential analgesic effects.
In terms of education, very few institutions focus on pain as a subject, said Tanra. “Pain education for health professionals at all levels has been repeatedly identified as an important step to changing ineffective pain management practices ... Education is the key to eradicate all barriers and prejudices [pertaining to opioid use],” he said.