MANILA, Philippines?Health Secretary Francisco Duque announced the availability of P10 million for the purchase of opioids (such as morphine) to alleviate the pain of poor patients suffering from cancer all over the country.

Duque made the announcement during the ?Workshop on Assuring Availability and Accessibility of Opioids Analgesics for Pain and Palliative? held last month at the Boracay Regency Hotel in Boracay Island, Aklan.

He said ?the Department of Health is grateful for every opportunity to review the country?s progress in our pain control efforts, to confront the ever-present challenges that come our way, and to embark on a renewed, collective effort with our partners as we map out our national strategies on pain control as well as our part in the global pain control efforts.?

According to him, the relief and management of cancer pain in the Philippines is benchmarked on the World Health Organization?s Three-step Ladder of Cancer Pain Management. The medical profession, he said before delegates from Indonesia, Thailand and the Philippines, has long recognized the unnecessary pain suffered by many patients but pain control has been a low priority issue in health care.

Necessary for pain relief

Duque said international policies and cancer pain guidelines also recognized that opioids are necessary for the relief of pain, and that national and local governments must ensure that these pain relief drugs are adequately available to meet the requirements.

Since cancer affects at least 200,000 Filipinos daily, he said the DoH has made pain control a part of its mission, laying the foundation for a prominent role in national pain control collaborations and partnerships.

According to him, the DoH has initiated three phases for the national program on cancer pain control.

? It targeted different stakeholders which resulted in top-line meetings and partnerships with various groups.

? Cancer pain control capability building workshops were conducted at the DoH regional level.

? A consultative workshop addressed the multisectoral concerns on morphine inaccessibility and other pain relief misconceptions.

Minimal use of morphine

Duque said morphine use in the Philippines was deemed minimal at only 0.14 kilogram per million population or a daily dose of only seven milligrams per day, as reported by the International Narcotic Control Board in 2004. He said that although there is no shortage of the need for morphine use, ?we lagged behind advanced countries and even from our Southeast Asian neighbors such as Thailand (12 mg per day), Singapore (31 mg per day) and Malaysia (18 mg per day).

Duque attributed such minimal showing to various factors like multisectoral barriers posed by physicians, patients and suppliers combined. He cited the underlying issues as morphine inaccessibility due to opioids regulatory issue, existence of morphine misconceptions at different levels, coordination issues between the stakeholders at the service level, etc.

The health secretary also enumerated the following reasons:

? Many physicians remain uncomfortable with the use of opioids apparently due to fear of drug addiction and other side effects.

? There is also a perception that these drugs are to be used as ?last resort? only and some of our doctors prefer weaker drugs.

? A good number of physicians are barred by technicalities such as incomplete prescription details and lack of authorized licenses to prescribe the drugs.

? Majority of physicians, who believe these pain relief drug are effective, do not have the required S2 licenses and yellow prescriptions.

? Patients have their share of misgivings about pain drugs for fear of addiction and side effects as well as propelled by our tolerance of pain.

? Availability of morphine is a significant problem, which is related to low demand and limitation of the so-called yellow prescriptions.

? Pharmacies and drug stores have perceived dispensing of drugs as a tedious requirement leading to inconsistent filling and refilling of prescriptions.

Filipino pain advocates

Duque said the emergence and fast-growing eminence of Filipino pain advocates such as the Pain Society of the Philippines and other working at the forefront of pain is a welcome.

?In the last few years we have seen the steady growth, not only in the ranks of pain advocates but more important, on the impact that they bring to the lives and consciousness of Filipinos in terms of pain control and management,? he said.