Pain free

The original article can be found in: Trinidad Newsday By JANELLE DE SOUZA

Health Minister, Dr Fuad Khan yesterday said he hopes to create a National Opiate Policy in order to make it easier for the country to receive the pain relief medications.

According to Khan, the need for opiates in palliative care and terminal pain relief is vital and so it was necessary to discuss an Opiate Policy with Chief Medical Officer, Dr Akenath Misir, in order to go to the International Narcotics Control Board (INCB) body to increase the country’s stock of opiates, such as morphine and oxycodone.

Speaking at the Palliative Care Society of Trinidad and Tobago conference at the Hilton Trinidad, Port-of-Spain, Khan stated that, even before he came to the Ministry, Dr Jacqueline Sabga, Vitas House, and the Trinidad and Tobago Cancer Society had been lobbying for Fentanyl patches as well as fast-release oxycodone tablets.

He noted that, in the process of applying to the INCB for more opiates based on the per capita of the country, legislation had to be addressed. “In order to buy more, and certain aspects of opioids, we need to have a stamp of approval from the international body. And even if we have their stamp of approval, the Food and Drug registration process takes too long to deal with it,” he said.

“The Food and Drugs Department of the Ministry of Health is a bit archaic in developing that process and I’m trying my best to deal with the legislation to make them more efficient. We have had meetings upon meetings and obviously they have not been going anywhere and I think legislation is the only way out of this now,” he continued.

Dr Dingle Spence, a Jamaican physician and Associate Lecturer at the University of the West Indies noted it was necessary for the Ministry to estimate of the amount of drugs necessary based on the population at risk, submit that estimate to the INCB, locate a wholesaler, issue a permit to the wholesaler allowing them to import the medication, and then send it to the supplier who ships it.

However, she said, drug availability was only one aspect as education and policy were also necessary.

“There is no point in having very well educated professionals that know how to prescribe medication if you don’t have the medication. There is no point in having the medication if nobody knows how to use it, and you need policy. You need your ministry involved, you need policies that say this is the way we are going, this is the way we do it,” she stated.

Spence added that policies on several issues were necessary including palliative care, how to transport the drugs to various facilities, and which medications were essential to have on hand at all times. Also, she noted that, in addition to health professionals, the public, families, care givers, and policy makers should be educated about opioids. The World Health Organisation defines palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

Khan stressed that palliative care should not only be the forte of nurses but also medical doctors, lab technicians, escorts who transfer the patients, and even security guards. He said palliative care was not just for terminal patients, but for everyone at all levels, from the time they enter a health facility to the time they leave.

He noted, the country’s first Palliative Care Ward at the Caura Hospital was complete with 12 beds, fully staffed and was soon to be opened. He said the Ward was reserved for “end stage patients” in need of extensive care, and that there were plans for more Palliative Care Wards throughout the country.

Khan also hoped to develop a specialisation in palliative care in order to “bring the practice up to international standards,” with consultants on the same level as consultants of neurosurgery.

He noted that there was already an MSc programme in Palliative Care at UWI, and said he would also like to develop a fellowship or Doctor of Medicine (DM) programme at the institution.

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