Strict drug policies deprive Filipinos of pain relief

MANILA, Philippines - Due to government’s strict and unreasonable policies on regulated drugs, many Filipinos suffering from pain are deprived of relief, according to the Pain Society of the Philippines (PSP).

At a health forum organized on Tuesday by the Philippine College of Physicians, former PSP president Francis Javier said doctors hardly prescribe opioids, main analgesic for severe pain, especially for acute or post-surgical pain, cancer and chronic non-cancer pain.

“We see patients – from the pediatrics to the very young, middle age to the geriatric population. When they come to us, we found they were just being given paracetamol or ibuprofen,” said Javier, also the president of Association of Southeast Asian Pain Societies.

He said these patients are not receiving the drug that they should get, that’s why they are in perpetual pain.

In 2012, around 59,000 Filipinos died of cancer, the group said.

“What is frustrating about this is that seven to eight Filipinos are dying every hour and around five to six of them will die without the benefit of opioids. Why? Because a lot of people, especially doctors, don’t prescribe opioids,” he said.

According to Javier, the Philippines is “right down there” in the global consumption of morphine.

He said while the global mean is 6.11 milligram (mg) per capita of morphine, the Philippines is actually at .6 mg per capita, which is very low.

“It says a lot of Filipinos suffering from pain don’t have access to these drugs,” he said.

Restrictive policies

According to Lu, Republic Act 9165 or the Comprehensive Dangerous Drugs Act of 2002 restricts doctors from using opioids in pain management.

The law imposes jail term and fines for unlawful and unnecessary prescriptions of dangerous drugs, but the definition of these two categories is not clear.

“What is unlawful and unnecessary? If you’re a doctor who earns a lot of money from surgery or dermatology, would you want an extra license so you can prescribe opioids for patients? Those are some of the barriers,” he said.

Doctors are required to secure yellow prescription pads before they can prescribe painkillers such as opioids or morphine.

Lu lamented the string of requirements that doctors must comply with before they could acquire the yellow prescription pads, aside from the fact that they have to purchase them.

“We need a balanced regulation. We’ve never been a primary source of abuse in this country. It’s easier for an addict to get illicit drugs from the street than going to a doctor to get a yellow prescription,” he said.

Not most abused drugs

Lu said that pain medicine is not the most abused drugs in the country, but uppers like “shabu and ecstasy.”

“We don’t prescribe shabu, ecstasy, heroin, marijuana, but we prescribe pain medicine for cancer patients. If we don’t change this concept, cancer patients are the ones having a hard time getting prescriptions,” he said.

He gave assurance that morphine would not lead to addiction if taken by a person who is suffering from severe pain.

Medical catastrophe

Former PSP president Henry Lu said the Philippines is a signatory to the 2005 Montreal Declaration, which states that access to pain management is a fundamental human right.

“Pain relief is a basic human right. Pain can be so bad that they ask us to help them go to the other side. Based on that, we consider it as an epidemic and some experts would say that it is a 21st century medical catastrophe,” Lu said.

He said it is the obligation of all health care professionals to give patients the option of adequate pain management. Otherwise, they are breaching the patients’ human rights.

“We’d like to emphasize that pain relief is a basic human right. It’s about time we have to be sensitive about this. A lot of patients are suffering in silence, especially in this part of the world.”