Krakauer Eric L, Nguyen Thi Phuong Cham, Husain Syeda Asra, Nguyen Thi Hai Yen, Joranson David E, Luong Ngoc Khue, Maurer Martha A
Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
Centre for Community Health Development, Hanoi, Vietnam.
J Pain Symptom Manage. 2015 May;49(5):916-22. doi: 10.1016/j.jpainsymman.2014.10.012. Epub 2014 Dec 15.
Moderate or severe pain is common among people with advanced cancer and other life-threatening illnesses. Yet despite agreement that pain relief is a human right, the poorest 80% of the world's population rarely have access to strong opioid analgesics. Excessively restrictive opioid policies, especially in developing countries, both stem from and propagate misguided fears about opioids, so-called opiophobia. Because opiophobia, like any norm, is historically, socially, and culturally situated, efforts to change opiophobic policies will be most effective if guided by awareness of their historical, social, and cultural determinants. We describe some of these determinants in Vietnam and report on results of an ongoing project there to allay opiophobia and improve safe access to opioids for medical uses. We used a method that entails working with committed local partners, including a high-level official from the Ministry of Health, to review all Vietnamese policies governing opioid accessibility to identify the barriers; devising an action plan to safely reduce or circumnavigate the barriers; obtaining buy-in for the plan from all stakeholders, including drug regulators and the police; and assisting the Ministry of Health to implement the plan. Since the start of the project, morphine consumption has increased each year and as of 2010 was ninefold greater than in 2003, and the number of hospitals offering palliative care has increased from three to 15. We conclude that this balanced policy method appears to be helping to reduce barriers to opioid access in Vietnam and should be used in other developing countries.
中重度疼痛在晚期癌症患者及其他危及生命的疾病患者中很常见。然而，尽管人们一致认为缓解疼痛是一项人权，但世界上最贫困的80%人口很少能获得强效阿片类镇痛药。过度严格的阿片类药物政策，尤其是在发展中国家，既源于对阿片类药物的错误恐惧（即所谓的阿片恐惧症），又助长了这种恐惧。由于阿片恐惧症与任何规范一样，都有其历史、社会和文化背景，如果在对其历史、社会和文化决定因素有所认识的指导下，改变阿片恐惧症政策的努力将最有成效。我们描述了越南的一些此类决定因素，并报告了该国正在进行的一个项目的成果，该项目旨在减轻阿片恐惧症，并改善医疗用阿片类药物的安全获取。我们采用了一种方法，即与包括卫生部一名高级官员在内的坚定的当地合作伙伴合作，审查越南所有关于阿片类药物可及性的政策，以确定障碍；制定一项行动计划，以安全地减少或绕过这些障碍；从包括药品监管机构和警方在内的所有利益相关者那里获得对该计划的认可；并协助卫生部实施该计划。自项目启动以来，吗啡消费量每年都在增加，截至2010年比2003年增加了九倍，提供姑息治疗的医院数量从三家增加到了15家。我们得出结论，这种平衡的政策方法似乎有助于减少越南阿片类药物获取的障碍，应在其他发展中国家使用。
