![Page 1: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/1.jpg)
Overviews of the Drug Distribution System & Barriers to Opioid
Availability
Dr. Bishnu Dutta Paudel
International Pain Policy Fellowship
Training ProgramMadison, Wisconsin, USA
6 August 2012
![Page 2: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/2.jpg)
GLOBAL DISPARITIES
• In 2010, eight countries together accounted for 85% of global consumption of morphine.
![Page 3: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/3.jpg)
Why is opioid use so low?INCB Survey of government drug control authorities 1995(65
countries) & 2007( 144 countries)
By: University of Wisconsin Pain & Policy Studies Group/WHO Collaborating Center, 2008
International Narcotics Control Board. (1996). Report of the International Narcotics Control Board for 1995: Availability of Opiates for Medical Needs. New York, NY: United Nations.
![Page 4: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/4.jpg)
Why is opioid use so low?
Barriers to opioid availability:
1) Fear of addiction
2) Lack of training health care providers
3) Excessively restrictive laws and regulations
4) Fear of legal consequences
![Page 5: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/5.jpg)
Why is opioid use so low?
5) Insufficient supply of opioids
6) Cost of opioids
7)Inadequate health care resources
8) Lack of national policy, guidelines
![Page 6: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/6.jpg)
Why is opioid use so low?
2006 Survey of Health care workers, and hospice/PC staff in Asia, Africa and Latin America
By: University of Wisconsin Pain & Policy Studies Group/WHO Collaborating Center, 2008
Adams, V. (2007). Access to Pain Relief – an essential human right. Help the Hospices, Worldwide Palliative Care Alliance.
![Page 7: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/7.jpg)
Why is opioid use so low?
Barriers to accessing oral morphine:
1) Excessively strict national drug laws and regulations;
2) Fear of addiction;3) Poorly developed health care systems;4) Lack of knowledge
![Page 8: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/8.jpg)
Barriers to opioid availability
1) Opioid Regulatory Policy
2) Drug Distribution System
3) Cost of Opioid Analgesics
4) Knowledge & Attitudes
![Page 9: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/9.jpg)
DRUG DISTRIBUTION SYSTEM
The entire system of medication procurement and distribution for health care.
![Page 10: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/10.jpg)
Op
ioid
An
alg
esi
cs
Info
rma
tion
Level 1: International Narcotics Control Board
Level 4: Hospitals / Pharmacies / Hospice/ PC facilities
Level 6: PATIENTS
Level 2: National Competent Authority
Level 3: Importers / Manufacturers / Distributors
Level 5: Physicians / Pharmacists / Nurses
![Page 11: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/11.jpg)
![Page 12: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/12.jpg)
![Page 13: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/13.jpg)
DRUG DISTRIBUTION SYSTEM BARRIERS
Government has not made procurement arrangements for importation or domestic manufacture of opioids
Delays in government decision-making
Inadequate methods for assessing medical needs
![Page 14: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/14.jpg)
DRUG DISTRIBUTION SYSTEM BARRIERS
Pharmacies that stock opioid medications are inadequate in number, in geographical location (rural areas), and/or hours of operation
No system to ensure the safe transport of medications from wholesale level to retail level
LACK OF DEMAND / Not ordered within country
![Page 15: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/15.jpg)
COST OF OPIOID ANALGESICS
-More expensive opioid analgesics available
- No reimbursement for pain management or palliative care in national policies
![Page 16: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/16.jpg)
COST OF OPIOID ANALGESICS
Lack of low-cost / generic oral opioid analgesics (powder to make into tablets or solution)
![Page 17: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/17.jpg)
CONCLUSIONS
Barriers to opioid availability and patient access can be found at different levels:
1) Opioid Regulatory Policy2) Drug Distribution System3) Cost of Opioid Analgesics4) Knowledge & Attitudes
-
![Page 18: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/18.jpg)
CONCLUSIONS
• Barriers must be identified and addressed in order to improve opioid availability to achieve pain relief.
• The International Pain Policy Fellowship is designed to assist with this process.
• Consider the barriers in your country before working on your Action Plans.
![Page 19: Overviews of the Drug Distribution System & Barriers to Opioid Availability Dr. Bishnu Dutta Paudel International Pain Policy Fellowship Training Program](https://reader036.vdocuments.us/reader036/viewer/2022062409/56649ed25503460f94be1415/html5/thumbnails/19.jpg)
THANK YOU !