Pain and Palliative Care Group, Universidad de la Sabana, Bogota, Colombia.
J Pain Symptom Manage. 2009 Nov;38(5):758-66. doi: 10.1016/j.jpainsymman.2009.03.007. Epub 2009 Sep 24.
Latin America consumes less than 2.7% of the morphine in the world, as reported by the governments to the International Narcotics Control Board. Methods to improve access to opioids for the treatment of pain have been developed by the Pain & Policy Studies Group (PPSG), a World Health Organization Collaborating Center at the University of Wisconsin. This article describes the preparation and implementation of an action plan in Colombia as a part of an international fellowship program on opioid policy developed by the PPSG and funded by the Open Society Institute. The action plan for Colombia included three steps: 1) a survey of regulators and health care providers to identify the current situation and their perceptions of opioid availability in the regions of the country; 2) a workshop with representatives of the Ministry of Health, the national and state competent authorities, pain and palliative care physicians, and international leaders; and 3) implementation workshops at the local level throughout the country. For the survey, response rates of 47% and 96% were registered among physicians and competent authorities, respectively. The survey identified significant regional differences in perceived opioid availability between physicians and regulators. Focus group discussions during the workshop identified several reasons leading to limited availability of opioids in the country, including deficiencies in the procurement process, insufficient human resources, excessive bureaucratic tasks, insufficient number of pharmacies authorized to dispense controlled medications in the country, lack of training in the health care professions, and overly restrictive laws and regulations governing opioid availability. The third step of the action plan has not been implemented. Additional and continuous monitoring needs to be implemented to measure the progress of this project.
据各国政府向国际麻醉品管制局报告，拉丁美洲消耗的吗啡不足世界总量的 2.7%。疼痛与政策研究小组（PPSG）是世界卫生组织在威斯康星大学的一个合作中心，该组织制定了增加阿片类药物获取以治疗疼痛的方法。本文描述了作为 PPSG 与开放社会研究所共同制定的阿片类药物政策国际研究金项目的一部分，在哥伦比亚制定和实施行动计划的情况。哥伦比亚的行动计划包括三个步骤：1）对监管人员和医疗保健提供者进行调查，以了解该国各地区的现状及其对阿片类药物供应的看法；2）与卫生部、国家和州主管当局、疼痛和姑息治疗医生以及国际领导人代表举行一次研讨会；3）在全国各地的地方一级举办实施研讨会。在调查中，医生和主管当局的回复率分别为 47%和 96%。调查发现，医生和监管人员对阿片类药物供应的看法存在明显的地区差异。研讨会期间的焦点小组讨论确定了导致该国阿片类药物供应有限的几个原因，包括采购过程中的缺陷、人力资源不足、过多的官僚任务、经授权可分发管制药物的药店数量不足、医疗保健专业人员缺乏培训以及监管阿片类药物供应的法律和法规过于严格。行动计划的第三步尚未实施。需要实施更多和持续的监测，以衡量该项目的进展。
