The Need for Regulatory Reforms in the Use of Opioids for Pain Management and Palliative Care in the Middle East.

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.