Basic human right to pain management often violated in PHL – group

“At least he didn't feel any pain.” It's a sentiment often uttered in movies about death and dying, but it's not something that can be said for those dying of cancer in the Philippines, with 65 to 75 percent of cancer patients suffering from unrelieved pain, according to the Pain Society of the Philippines (PSP).

Pain management was declared a fundamental human right at the Declaration of Montreal—a global agreement that arose from the the International Pain Summit (IPS) of the International Association for the Study of Pain (IASP) and members of the international medical community in 2010—but it remains a low-priority healthcare issue in the Philippines, said the group.

In 2002, the World Health Organization asserted that governments “have an obligation...to ensure availability of opioid analgesics for medicinal purposes.”

Opioids are medications that relieve or alleviate pain, such as morphine and codeine.

Serious public health issue

Chronic pain is a problem worldwide, but developing countries are at a significant disadvantage. At the forum on pain management—held on Tuesday by the Philippine College of Physicians (PCP) in cooperation with the PSP and the 6th Congress of the Association of Southeast Asian Pain Societies (ASEAPS)—it was revealed that 84 percent of the world's morphine supply is already consumed by seven developed countries with 12 percent of the world's population.

Makati Medical Center head of pain management Dr. Henry Lu noted that each year, 4.3 million cancer patients worldwide die of inadequate control of chronic pain.

“The underlying issues include inaccessibility due to regulatory issue, misconceptions at different levels—including the patients and doctors, and at times, coordination issues between stakeholders at the service level,” said Dr. Francis Javier, president of the 6th Association of Southeast Asian Pain Societies Congress (ASEAPS), in a press release.

Pain management is especially lacking among cancer patients living at the poverty level. Eight Filipinos will die every hour of chronic pain, and worse, five to six of them will perish without intaking any strong opioids.

“And as long as poverty remains in our midst, access to opioid drugs will be very difficult,” Javier said.

Opioids in the right hands

According to the pain society, the most effective pain reliever for those with cancer are opioids like morphine. Opioids are essential analgesics in the treatment of post-surgical pain, cancer pain, and severe non-cancer chronic pain.

They are different from opiates in that opiates are the alkaloids that occur naturally in opium, or the resin. Meanwhile, opioids are the semi-synthetic substance derived from opium poppy.

Javier noted that in considering the safety of opioids or morphine for chronic pain sufferers:

• It is safe in trained hands.
• It is available in multiple routines of administration.
• There is ease of titration or “the slow addition of one solution of a known concentration (called a titrant) to a known volume of another solution of unknown concentration until the reaction reaches neutralization.”
• It is reliable.
• It is effective.

However, the Philippines is very low on the list of morphine consumers, with only 0.22 mg per capita consumed in 2004. As of 2011, the country is still very much below the global mean of 6.11 mg per capita.

The reason for this, Javier stated, is the risk of opioid abuse.

Barriers to opioid administration

According to data from the International Narcotics Control Board (INCB) as of 2010, the Philippines has 6.7 million drug abusers. The INCB had noted in 1996 that governments are “concerned about addiction,” and are therefore reluctant to support the use of medical opioids.

Lu explained that according to RA 9165, or the Comprehensive Dangerous Drugs Act of 2002, those caught prescribing unlawful dangerous drugs will be penalized with life imprisonment or death, fined anywhere between P100,000 to P500,000, and have their license to practice revoked. Meanwhile, an unnecessary prescription of a dangerous drug will net 12 to 20 years in prison; the fines and license revocation remain the same.

In addition, medical practioners who will prescribe dangerous drugs must obtain S2 licenses from the Philippine Drug Enforcement Agency (PDEA). S2 licenses are given only to physicians, dentists, and veterinarians authorized by law to prescribe dangerous drugs.

Javier said that there are five barriers to opioid use in the Philippines:

• The fear of addiction.
• The need for an S2 license.
• The need for yellow prescriptions when purchasing dangerous drugs.
• The difficulty in applying for an S2 license.
• The penalties for losing the S2 license.

'Painful realities'

In its statement at the PCP health forum on Tuesday, the PSP declared that the field of pain medicine is a complex one because "we not only deal with the patient’s pain itself but also the painful realities that surrounds it."

These realities, the group added, "are the social, psychological, cultural and other factors that undermine what we do in pain management. Because although science and technology have long established—and continues to enhance—the protocols and medications to properly assess, recognize and treat pain, there still exists circumstances that prevent widespread access to pain relief.

"Among them government policies or initiatives, the insufficiency of public knowledge and push from the medical community, and the overall behavior or misgivings of patients to receive appropriate pain treatment despite their needs."

The group added that it hopes to send the message that pain should be properly relieved. It added that the PSP and the organizers of ASEAPS believe it is possible to change the current situation "by arming ourselves—patients, families, and healthcare personnel alike—with correct knowledge and behaviors on pain and pain relief."

The 6th ASEAPS Congress will be held in the Philippines from March 15 to 17.  — Vida Cruz/BM, GMA News