Al Bahrani Bassim Jaffar, Mehdi Itrat
National Oncology Center, The Royal Hospital, Muscat, Sultanate of Oman.
Gulf J Oncolog. 2018 May;1(27):52-59.
Palliative Care (PC) is an evolving oncology subspecialty in the Middle East (ME). Justified opioid use is an integral part of palliative care. Often, morphine consumption is taken as a quality indicator of palliative care services, but is it a reliable indicator to reflect the status of palliative care in current Middle East setting? We need to understand that data on morphine consumption, represent the amount distributed of morphine per person in a country and does not refer the actual justified amount utilization of opioids. In addition, the currently used consumption data is not reflective of product and dosage employed. It includes opioid use in other conditions like post-operative pain, traumatic pain, and drug abuse as well. The population and cancer incidence is highly variable amongst countries. The opioid consumption reported at present in Oman is very low 0.5474 mg/person. The opioid prescription must have an appropriate validated policy, well administered and enforced effectively. The policy must be balanced in such a way to eliminate the barriers of availability on one hand, and limit the probability of abuse on the other. Ideally there should be a national empowered competent control authority which should estimate the needs, license, distribute, monitor and report opioid use. There is an additional need to train health care workers in adequate pain assessment, effective pain management, and validated opioid prescribing practices. The issues in the Middle Eastern (ME) countries are erratic and undependable cancer data, limited palliative care programs, non-effective or no palliative care/pain management policies, and almost non-existent prescription policies of controlled drugs. There is an urgent and essential need to work for comprehensive and integrated palliative care programs encompassing the subspecialties. It must include and care for local perspectives of psychological, social, spiritual, and religious issues in PC in addition to pain management. There remains a need for health education for population, advocacy for policy makers, and a political will at the appropriate levels to meet these challenges.
姑息治疗（PC）在中东地区（ME）是一个不断发展的肿瘤学亚专业。合理使用阿片类药物是姑息治疗不可或缺的一部分。通常，吗啡消耗量被视为姑息治疗服务的质量指标，但在当前中东地区的背景下，它是否是反映姑息治疗状况的可靠指标呢？我们需要明白，吗啡消耗量数据代表的是一个国家每人分配到的吗啡量，而非阿片类药物实际合理使用量。此外，目前使用的消耗量数据并不能反映所使用的产品和剂量。它还包括阿片类药物在其他情况（如术后疼痛、创伤性疼痛和药物滥用）中的使用。各国的人口和癌症发病率差异很大。目前阿曼报告的阿片类药物消耗量非常低，为0.5474毫克/人。阿片类药物处方必须有适当的经过验证的政策，妥善管理并有效执行。该政策必须保持平衡，一方面消除供应障碍，另一方面限制滥用的可能性。理想情况下，应该有一个国家授权的主管控制机构，负责评估需求、发放许可证、分发、监测和报告阿片类药物的使用情况。此外，还需要培训医护人员进行充分的疼痛评估、有效的疼痛管理以及经过验证的阿片类药物处方实践。中东国家存在的问题包括癌症数据不稳定且不可靠、姑息治疗项目有限、姑息治疗/疼痛管理政策无效或不存在，以及几乎没有受控药物的处方政策。迫切需要开展全面综合的姑息治疗项目，涵盖各个亚专业。除了疼痛管理外，还必须纳入并关注姑息治疗中当地在心理、社会、精神和宗教问题方面的观点。仍然需要对公众进行健康教育，向政策制定者进行宣传，并在适当层面上有政治意愿来应对这些挑战。
