‘White Paper on Opioids and Pain: A Pan-European Challenge’: Media Backgrounder

What is the ‘White Paper on Opioids and Pain: A Pan-European Challenge’
The ‘White Paper on Opioids and Pain: A Pan-European Challenge’ ¹ is a pan-European policy document compiled by leading pain management specialists to raise awareness of the barriers to access of opioids for the treatment for chronic pain across Europe.

How was the document compiled?
The document is based on the results of comprehensive qualitative research carried during 2003 / 2004. A detailed questionnaire was sent to 35 physicians in 17 European countries to seek preliminary information about regulations governing opioid prescription, reimbursement policies and driving status for patients. Following this initial research, an expanded set of questions was delivered via interviews with 32 additional European physicians. Responses were cross-referenced against governmental official documents, with the subsequent results, disparities and issues presented within the Breaking Pain Barriers White Paper.

What did the Research reveal?
The ‘White Paper on Opioids and Pain: A Pan-European Challenge’ paints a picture of considerable regulatory and economic barriers to opioid prescription, contributing to stigma and misunderstanding about these medicines:

In every country in Europe, prescriptions for strong opioids must be filled in differently from those for other medicines
In Austria, Denmark, Finland, France, Germany, Italy, Poland, Portugal, Spain, Sweden, and Switzerland, the prescription forms for strong opioids themselves are different to those for other medicines
In Italy, Poland, Portugal and parts of Spain, doctors must travel in person to regional offices in order to access prescription forms for strong opioids
In Portugal, private doctors must even pay for the forms themselves
In Austria, Germany, Portugal, Italy and Switzerland, triplicate forms must be filled in
In Germany, narcotic prescription forms are only valid for one week
There is a huge imbalance across Europe in the amount of opioid medication that a doctor can prescribe to a patient at any one time, ranging from 10 days worth of treatment (Israel) to countries where doctors are free to prescribe according to the needs of the patient
In Austria, narcotics are referred to as Suchtmittel literally “the means to make you addicted”, whilst the prescription forms are known as “Suchgiftrezepte”, or “addictive poison prescription forms.
In Germany, narcotics are referred to as “Betäubungmitteln”, literally “the means to knock you out”
In Finland, pharmacists must keep prescription forms for 10 years
In the Netherlands and Belgium, people taking strong opioids are forbidden from driving, despite consensus in the medical community that untreated pain patients present a greater safety risk
In France, only morphine is authorised for treatment of non-cancer pain
In Poland, only one strong opioid for non –cancer pain is reimbursed, and at a rate of only 50%

What is the purpose of the document?
The ‘White Paper on Opioids and Pain: A Pan-European Challenge’ includes a Call to Action for European Governments, designed to help them combat the inadequacy of access to pain treatments by addressing the barriers, stigma, and the regulatory and economic factors that cause them:

General:

European governments should review existing policies affecting access to strong opioids for use in pain management.
These policies should have as their primary goal the provision of appropriate treatment to people suffering from chronic pain.

Regulatory:

Whenever strong opioids are prescribed, excessive and burdensome regulations should not cause stigma, inconvenience or cost for patients or healthcare professionals.
All doctors should have free and easy access to the forms necessary for prescribing strong opioids. Prescription lengths for strong opioid treatments should reflect the needs of the individual patient and should recognise the importance of regular monitoring by the prescribing doctor.

Economic:

Governments should recognise the rights of people with chronic pain to access the full range of treatments available to manage it. All authorised treatments should be reimbursed to the same level, irrespective of the root cause of the pain.
Financial factors should not prevent patients from gaining access to the pain treatments that they need.
Reimbursement levels for treatments of non-cancer pain should not differ from those for cancer pain.

Stigma:

Governments should take the lead in combating the stigma surrounding strong opioids amongst patients, the general public and the medical community by promoting their effectiveness in giving back quality of life and educating about the management and reduction of expected side effects.
Strong opioids, particularly when consumed at a stable dose, should not be an absolute contraindication against driving. The decision of whether to drive whilst taking strong opioids should be made by the patient in consultation with the prescribing doctor.
Governments need to ensure that pain management and the role of opioids in pain management form a more substantial part of undergraduate training and continuing medical education.

Who was involved in compiling the ‘White Paper on Opioids and Pain: A Pan-European Challenge’?
The white paper was commissioned by the OPEN Minds (Opioids and Pain European Network of Minds) group, a pan-European group expert group comprising of 25 leading pain management specialists from 14 countries, with an educational grant provided by Mundipharma International Limited of Cambridge, UK. OPEN Minds is committed to helping healthcare professionals increase their knowledge and understanding in managing pain, in order to address concerns about using opioids to treat chronic pain and thereby raising the standards of pain management across Europe.

Why is the ‘White Paper on Opioids and Pain: A Pan-European Challenge’ Important?
The White Paper is an important tool for highlighting the current stigma, regulatory and economic barriers surrounding strong opioids in European pain management. It is hoped that the Call to Action contained within the document will help reinforce previous recommendations and help European governments identify how best to combat the inadequacy of access to pain treatments.

A consensus issued by the Committee of Ministers of the Council of Europe in November 20032 declared “Legislations should make opioids and other medicines accessible in a range of formulations and dosages for medical use. The fear of abuse should not hinder access to necessary and effective medication. Countries may wish to consider whether this will require new legislation or an amendment to existing legislation.”

OPEN Minds, in conjunction with their collaborative European representatives, call for the revision of healthcare policies in those governments for which the provision of appropriate pain treatment is not a primary goal. The White Paper urges governments to take the lead in combating the stigma surrounding strong opioids amongst patients, the general public and the medical community by promoting their effectiveness in giving back quality of life and educating about the management and reduction of expected side effects.

References:

‘White Paper on Opioids and Pain: A Pan European Challenge’. The OPEN Minds Group, June 2005
Committee of Ministers of the Council of Europe as part of its Recommendation (2003) 24 to Member States on the organization of palliative care; 12 November 2003.

Sponsored by an educational grant from Mundipharma International Limited, Cambridge.