Third in a series
MANILA, Philippines?In the Philippines, many patients suffering from cancer and other serious illnesses have long been deprived of adequate pain relief they need. Concerned doctors and patients have apprehensions about addiction and dependency from opioids like morphine. Because of this, there is subdued and low usage of opioids for pain relief.
Most doctors in the country still hesitate to prescribe for patients writhing in pain. The prohibitive costs of opioids and heavy restrictions in its procurement and prescription further aggravate the availability and accessibility of these controlled medicines.
Yet there is no denying the essential role of pain management and palliative care in ensuring the highest attainable standards of health and quality of life of patients suffering from terminal illnesses like cancer.
During the ?Workshop on Assuring Accessibility and Availability of Opioid Analgesic for Pain and Palliative Care,? various sectors in government and nongovernment tackled issues that beset opioid usage and identified possible course of actions and solutions for them.
The workshop was co-organized by the American International Health Alliance Twinning Center, Open Society Institute (OSI), International Palliative Care Initiative, National Hospice and Palliative Care Organization (USA), Pain and Policy Studies Group (PPSG), World Health Organization Collaborating Center for Policy and Communications in Cancer Care, University of Wisconsin, and Pain Society of the Philippines (PSP).
Country teams
The Philippines, Indonesia and Thailand are the three Southeast Asian countries that participated in the workshop. Comprising each country team were different members involved at different aspects of opioid usage, including regulation, distribution, enforcement, prescription and dispensing, retail and end-use.
The Philippine country team for the workshop was composed of representatives from government regulatory bodies Department of Health (DOH), Philippine Drug Enforcement Agency (PDEA), Dangerous Drugs Board (DDB) and Philhealth. Major NGOs and professional groups involved in pain management such as PSP, Hospice Philippines and several pain centers (St. Luke?s Medical Center, Manila Doctors Hospital, etc.) as well as private companies (Mercury Drugstore) in the country also took part in the workshop.
Dr. Antonio Villalon, one of the country?s eminent medical oncologists and a proponent of the ?Philippine Cancer Control Program,? said pain management is an important component of the national cancer control agenda for improving the quality of life of cancer patients.
The program led by the DOH, Philippine Cancer Society and other related groups started in 1986 and has adapted the WHO analgesic ladder of pain management and relief.
However, 20 years after the introduction of the WHO analgesic ladder to the Philippines, the barriers to opioid prescribing still persist, said Dr. Francis Javier, director of St. Luke?s Pain Management Center. He attributed this to the different factors caused by physicians, patients, families and the constraints imposed by government regulatory bodies.
Also contributing to the sluggish state of opioid analgesics usage for pain and palliative care in the country were problems in distribution and decreasing government subsidy for opioid medication over the past years.
The steady increase?from less than 15 kilograms in 1999 to 20.7 kg in 2005?in the country?s morphine consumption has not affected its standing in opioid usage. The Philippines is still lagging behind developed countries and even other neighboring Southeast Asian nations.
Expected to get a boost
It was during the workshop that Health Secretary Francisco T. Duque III announced the government?s commitment of P10 million for morphine procurement, to benefit mainly the poor Filipino patients suffering needlessly from pain. Because of this, the country?s relative shortfall in morphine use is soon expected to get a boost.
According to PSP President Dr. Henry Lu, the renewed government support for morphine and other opioid analgesics for pain relief is a huge stride for the advocacy in pain management and palliative care, especially since it was complemented by a reinforced multisectoral commitment for greater opioid accessibility and availability.
The workshop also led to a renewed collaboration between doctors and other healthcare professionals, private sector and government agencies.
Technical working group
The organizations to which doctors and other healthcare professionals belong now comprise the technical working group whose main objective is to develop and implement policies and activities to improve opioid accessibility and availability for pain and palliative care in the country.
The technical working group is led by Doctors Lu and Ivanhoe Escartin (Department of Health) as overall chairpersons. The different committees of the group include the regulations committee chaired by Dr. Antonio H. Villalon (Philippine Cancer Society) and co-chaired by Undersecretary Romeo Vera-Cruz (DDB) with Erwin Espinosa (Mundipharma), Arlene G. Ramos (Zuellig), Corazon Cruz and Eden Fernandez (Mercury Drug), Marlyn del Rosario (Johnson & Johnson) and Dr. Frank Diza (DOH) as members.
The finance committee, chaired by Shirley Domingo (Philhealth) and co-chaired by Dr. Rachel Rosario (Hospice Philippines), has its members Dr. Ben Reyes (DOH), Lilian Hizon and Dr. Ernie Vera (DOH).
Education and information, promotion and compliance committee is chaired by Helen Reyes and co-chaired by Dr. Lorina Cabaluna with Undersecretary Edgar Galvante (DDB), Commodore Romeo Sanga (PDEA), Assistant Secretary Rodolfo N. Caisip, (DDGO), Assistant Secretary Baltazar Balangauan (DDGA), Drug Association of the Philippines, Hospital Pharmacists Association of the Philippines as members.
The secretariat committee is composed of Sylvia C. Palma (ACES) and Agnes Mandap (PDEA).
Advocacy management group Advocacies Convergence & Events Strategists (ACES) organized the workshop and is coordinating the succeeding collaborative activities of the technical working group.
