RESUMO
La liberación del uso terapéutico de los opioides se ha hecho cada vez mas frecuente como una propuesta para mejorar la distribución de éstos en las instituciones de salud pública y privadas con el fin de garantizar su alcance a población que cursa con dolor. A pesar de esto, aún no se logra una distribución homogénea de estos recursos en la población requirente. El objetivo de este trabajo es dar a conocer el panorama actual de los opioides en México y algunos países sudamericanos.
The release of therapeutic opioid use is mentioned with increasing frequency as a proposal to improve their tion in Public and Private Health Care Institutions, in order to scope opioids to population who needs them. Although this, homogeneous distribution of opioids is not achieved. The aim of this paper is to present the current panorama of opioids in Mexico and Latin American countries
Assuntos
Humanos , Dor/tratamento farmacológico , Cuidados Paliativos/organização & administração , Manejo da Dor , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , Analgésicos Opioides/provisão & distribuição , Analgésicos Opioides/uso terapêutico , Morfina/provisão & distribuição , Morfina/uso terapêuticoRESUMO
OBJECTIVE: Limited information has been published about opioid prescribing practices in Puerto Rico. The objective of this study was to create baseline trends of opioids distributed over a period of fourteen years in Puerto Rico. METHODS: We examined data from the U.S. Drug Enforcement Administration's Automation of Reports and Consolidated Orders System (ARCOS) for the period 1999-2013. ARCOS data reflects the amount of controlled substances legally dispensed. Analyses include the distribution of opioids (in morphine milligram equivalent kg per 10,000 persons) by year and entity (pharmacy, hospital, practitioner). RESULTS: The distribution of four drugs (fentanyl, hydromorphone, methadone, oxycodone) increased over 100% between 1999 and 2013. The distribution of two drugs (hydrocodone and meperidine) declined between 1999 and 2013. Oxycodone distribution grew from 0.13 MME kg grams per 10,000 persons in 1999 to 0.29 MME kg in 2013. CONCLUSION: ARCOS data showed that the overall amount of opioid pain relievers distributed in Puerto Rico increased by 68% between 1999 and 2013. Currently, prescription opioid pain reliever overdose deaths in Puerto Rico do not appear to be skyrocketing as they are in the mainland U.S. However, the ongoing problem with prescription opioid pain reliever overdoses in certain areas should serve as a warning to monitor consumption of opioid pain relievers, as well as changes in prescription drug abuse, overdoses, and deaths.
Assuntos
Analgésicos Opioides/provisão & distribuição , Prescrições de Medicamentos/estatística & dados numéricos , Tratamento Farmacológico/tendências , Humanos , Porto Rico , Fatores de TempoRESUMO
Access to palliative care is insufficient in many countries around the world. In an effort to improve access to palliative care services and treatments, a public health approach as suggested by the World Health Organization was implemented in Colombia to improve opioid availability, increase awareness and competences about palliative care for healthcare workers, and to include palliative care as a component of care in legislation. As a result, opioid availability has improved, a mandatory palliative care course for medical undergraduate students has been implemented and a palliative care law is being discussed in the Senate. This article describes the strategy, main achievements and suggestions for implementing similar initiatives in developing countries.
Assuntos
Analgésicos Opioides/provisão & distribuição , Prestação Integrada de Cuidados de Saúde/organização & administração , Países em Desenvolvimento , Cuidados Paliativos/organização & administração , Administração em Saúde Pública , Colômbia , Prestação Integrada de Cuidados de Saúde/legislação & jurisprudência , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/normas , Política de Saúde , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Cooperação Internacional , Cuidados Paliativos/legislação & jurisprudênciaRESUMO
The World Health Organization classifies opioid analgesics as essential medicines in the treatment of severe pain and recommends their increased availability. The combination of availability, training of professionals, and a legal framework granting access to these medicines has led to a sharp increase in the consumption of morphine and other opioids in developed countries. However, in Colombia, consumption of opioid analgesics appears to fail to meet patient needs. To analyze the current trends in medical consumption of opioids in Colombia, the numbers of defined daily doses of opioid analgesics for total inhabitants and the population that died of cancer between 1997 and 2007 were calculated and compared. The import of raw materials and medicines varied greatly every year. However, from 2003, a trend toward the increased consumption of morphine, hydromorphone, and methadone was observed. Availability was inconsistent and opioid consumption showed an increase when calculated for total inhabitants and for cancer deaths. The unreliable availability of opioid analgesics may be responsible for their limited consumption. Chronic underuse and a trend toward increased consumption have been confirmed. Monitoring of consumption to promote rational use is recommended.
Assuntos
Analgésicos Opioides/administração & dosagem , Dor/tratamento farmacológico , Analgésicos Opioides/provisão & distribuição , Colômbia , Bases de Dados Factuais , Acessibilidade aos Serviços de Saúde/tendências , Humanos , Neoplasias/complicações , Neoplasias/etiologia , Dor/epidemiologia , Dor/etiologia , Estudos Retrospectivos , Organização Mundial da SaúdeAssuntos
Analgésicos Opioides/provisão & distribuição , Controle de Medicamentos e Entorpecentes , Acessibilidade aos Serviços de Saúde , Dor/prevenção & controle , Analgésicos Opioides/uso terapêutico , Colômbia , Feminino , Humanos , Cooperação Internacional , Transtornos Relacionados ao Uso de Opioides/reabilitação , Organização Mundial da SaúdeRESUMO
As in other developed and developing countries, the most common chronic disorders affecting the Chilean population are cardiovascular disease, cancer, cirrhosis, diabetes, chronic obstructive pulmo- nary disease and external injuries. Availability of oncology services is not extensive and there are no academic programs to adequately train practitioners in either palliative medicine or comprehensive palliative care for allied health professionals including nurses, psychologists and chaplains. Major efforts have been made to incorporate palliative care as an important health care focus in the last decade and in the development of effective policies for opioid availability. Chile now meets 84% of the 17 criteria outlined by the World Health Organization and the International Narcotics Control Board for opioid availability. Postgraduate medical education in symptom control, clinical use of opioids and end-of-life care remains relatively poor as judged by the results of a questionnaire administered to 158 resident physicians at the Pontificia Universidad Católica de Chile. Improvements in symptom control and the development of palliative care in Chile will depend on the effective assessment of symptom control effectiveness and improved education and training of health professionals in clinical pharmacology, symptom control, clinical ethics, and end-of-life care.
Assuntos
Analgésicos Opioides/provisão & distribuição , Doença Crônica , Política de Saúde , Cuidados Paliativos/métodos , Assistência Terminal/métodos , Analgésicos Opioides/uso terapêutico , Chile/epidemiologia , Doença Crônica/tratamento farmacológico , Doença Crônica/mortalidade , Educação de Pós-Graduação em Medicina , Humanos , Internato e Residência , Oncologia/educação , Morfina/provisão & distribuição , Morfina/uso terapêutico , Programas Nacionais de Saúde , Cuidados Paliativos/normas , Desenvolvimento de Programas , Inquéritos e Questionários , Assistência Terminal/normas , VoluntáriosRESUMO
Argentina is a large South American country with a high prevalence of chronic disease-related mortality and a clear need for implementation of palliative care. Primary concerns related to palliative care are cultural, socio-economic and educational. Increasing poverty, patients and families receiving inadequate information about their diagnosis or prognosis, drug availability and costs, and insufficient knowledge by health care providers are obstacles to palliative care. Palliative care programs are developing throughout the country and methods by which they are meeting their needs are described. Several Argentinean palliative care initiatives are described and the role of the Pallium Latinomérica training program is discussed.