Skip to content


Cancer Pain is “Public Health Catastrophe” in Europe

Nick Mulcahy

Health Editor’s note: In the United States evaluation of a patient’s pain level or intensity has become the fifth vital sign.  The level of pain as well as blood pressure, pulse, respirations, and temperature are repeatedly noted and recorded as a patient is evaluated.  Pain has been shown to have a detrimental effect on a person’s well-being, healing ability, and quality of life. While use of opioids for pain management meet regulative qualifications to prevent overdosing and improper use here in the United States, part of the world still views helpful use of opioids for pain reduction with a jaundiced eye.  Part of Europe has extreme regulations for opioid availability and use  in place and these regulations can detrimentally affect the lives of those with cancer.  The helpful effects of opioids to decrease pain levels is lost when the patient cannot receive the pain relieving drug in a timely fashion.  Carol Ware Duff, MSN, BA, RN

February 24, 2010 — Patient access to medication to relieve cancer pain is “profoundly restricted” in many European countries. The resulting undertreatment of cancer pain and the related suffering are a “public health catastrophe,” according to a new report.

The problem is most prevalent in Eastern Europe, where a combination of misconceptions about opioid medications and fears about their illicit use have led to severe regulations.

For instance, in Georgia, dispensing privileges for outpatient opioids are restricted to special pharmacies in district police stations.

In Ukraine, prescriptions for opioids are limited to a 1-day supply, compared with the 90-day supply allowed in countries such as Sweden, the Netherlands, and Finland.

In some countries, clinicians fear criminal prosecution and therefore deliberately undertreat pain in cancer patients, according to the report, which was issued jointly by the European Society for Medical Oncology (ESMO) and the European Association for Palliative Care (EAPC).

The report, published in the March issue of the Annals of Oncology, uses findings from a 2007/08 survey of senior clinicians holding leadership positions in their respective European countries in oncology or palliative care.

The survey collected data about drug formularies and regulations from 21 Eastern European countries and 20 Western European countries, including Israel.

”Clinicians everywhere have congratulated us on bringing this situation to light, with the hope that exposure and discussion will prompt the relevant authorities into action,” said lead author Nathan Cherny, MD, referring to earlier presentation of data from the report at meetings in Europe.

Dr. Cherny, who is from Shaare Zedek Medical Center in Jerusalem, Israel, and is a member of the Palliative Care Working Group of ESMO, said that there needs to be a balance between good patient care and diversion protection.

However, the idea of balance has fallen on deaf ears in many governments, he suggested.

”The International Narcotic Control Board and the World Health Organization [WHO] have recommended legislative guidelines and have been promoting them for years,” he told Medscape Oncology.

Declarations by public bodies seeking adequate provision of narcotics for pain relief date from at least 1961, according to an editorial about the report published online February 22 in Palliative Care.

There has been little change in the last 20 years in Eastern Europe.

In recent decades, Eastern Europe continues to be a problem area, note editorialist James Cleary, MB, from University of Wisconsin Carbone Cancer Center in Madison, and his 2 colleagues.

”While there has been a significant increase in opioid consumption in Western Europe, there has been little change in the last 20 years in Eastern Europe,” note the editorialists.

Formularies and Cost: Eastern vs Western Europe

The principle aim of the new ESMO/EAPC report is to “evaluate and report on opioid availability and the legal and regulatory barriers to accessibility across the countries of Europe.”

To determine availability, the authors looked at national formularies in relation to the WHO essential drugs list (codeine; and oral immediate-release, oral controlled-release, and injectable morphine) and the International Association for Hospice and Palliative Care list of essential medicines for palliative care (the same drugs as the WHO, plus oral immediate-release oxycodone; fentanyl transdermal; and oral immediate-release methadone).

To assess overregulation, the authors used the principles derived from the WHO guidelines on opioid regulations and compared them with each country’s regulations.

Except for Greece and Turkey, the opioid formularies of most countries in Western Europe provide a range of options with different opioids.

In the majority of Western European countries, most opioids are available at no cost to patients with cancer pain, the report authors note.

Eastern Europe is a different story. The opioid formularies in “many Eastern Europe countries are substantially limited,” notes the report.

Some countries, such as Croatia, the Czech Republic, Estonia, Hungary, Latvia, Rumania, Serbia, and the Slovak Republic, provide all essential medicines and most are either free or available at a subsidy of more than 75%.

However, there are “severe formulary deficiencies” characterized by unavailability of essential medicines in Albania, Belarus, Georgia, Lithuania, Tajikistan, and Ukraine.

Bureaucratic Impediments, Even in Western Europe

In general, the countries with the most limited opioid formularies tend to have the greatest number of regulatory barriers to accessibility, observe the study authors.

Most of the Eastern European and a minority of the Western European countries require that patients, particularly outpatients, receive a permit or be registered to be eligible to receive opioid prescriptions for the management of cancer pain — even in hospices in some cases, write the study authors.

In various Eastern European countries, prescribing physicians must also have a permit. All Eastern and most Western European countries require prescriptions in duplicate or triplicate. Special forms must be used and difficulties occur in getting the forms from the government. In Albania, Denmark, Estonia, and Latvia, physicians need to purchase their prescription forms, report the authors.

Prescription limits vary widely throughout Europe. Many of the Eastern European countries restrict opioid prescriptions to a supply of less than 3 weeks, and Albania, Belarus, Georgia, Lithuania, Moldova, Russia, and Ukraine restrict supply to a week.

Another major problem throughout Europe is that “few” countries allow physicians to prescribe by phone or fax. This hampers any kind of emergency pain management, especially at night or when patients are away from their homes.

The study authors also note that at least 10 of the countries evaluated referred to opioids with stigmatizing terms in their regulations, including “dangerous drugs” and “poisons.”

The ESMO/EAPC report makes a series of “major recommendations,” perhaps the most notable being that governments repeal “over vigilant or excessive restrictions that impede good clinical care of cancer pain.”

The report was funded by ESMO and EAPC.

Ann Oncol. 2010;21:615-626. Abstract
Palliat Med. Published online February 22, 2010. Abstract

Authors and Disclosures


Nick Mulcahy

Nick Mulcahy is a senior journalist for Medscape Hematology-Oncology. Before joining Medscape, Nick was a freelance medical news writer for 15 years, working for companies such as the International Medical News Group, MedPage Today, HealthDay, McMahon Publishing, and Advanstar.

View the original article at Veterans Today

Related Posts with Thumbnails

Posted in Health Care, Rants & Opinion.

Tagged with , , , , .

0 Responses

Stay in touch with the conversation, subscribe to the RSS feed for comments on this post.

Some HTML is OK

or, reply to this post via trackback.

Support #altnews & keep Dark Politricks alive

Remember I told you over 5 years ago that they would be trying to shut down sites and YouTube channels that are not promoting the "Official" view. Well it's all happening now big time. Peoples Channels get no money from YouTube any more and Google is being fishy with their AdSense giving money for some clicks but not others. The time is here, it's not "Obama's Internet Cut Off Switch" it's "Trumps Sell Everyones Internet Dirty Laundry Garage Sale". This site must be on some list at GCHQ/NSA as my AdSense revenue which I rely on has gone down by a third. Either people are not helping out by visiting sponsors sanymore or I am being blackballed like many YouTube sites.

It's not just Google/YouTube defunding altenative chanels (mine was shut), but Facebook is also removing content, shutting pages, profiles and groups and removing funds from #altnews that way as well. I was recently kicked off FB and had a page "unpublished" with no reason given. If you don't know already all Facebooks Private Messages and Secret Groups are still analysed and checked for words related to drugs, sex, war etc against their own TOS. Personally I know there are undercover Irish police moving from group to group cloning peoples accounts and getting people booted. Worse than that I know some people in prison now for the content they had on their "secret private group". Use Telegrams secret chat mode to chat on, or if you prefer Wickr. If you really need to, buy a dumb phone with nothing for the NSA/GCHQ to hack into. Ensure it has no GPS tracking on it and that the battery can be removed. These are usually built for old people to get used to technology storing only a set of numbers to call. However they have no games, applications to install or other ways people can exploit the computer tracking device you carry round with you most of the day - your smart phone. If you are paranoid ensure that you can remove the battery when travelling around and do so to prevent GPS tracking or phone mast triangulation. Even with your phone in Flight mode or turned off, it can be turned on remotely and any features like front or back cameras, microphones and keylogging software can be installed to trace you.

So if your not supporting this site already which brings you news from the Left to the Right (really the same war mongering rubbish) then I could REALLY do with some..

Even if it's just £5 or tick the monthly subscription box and throw a few pound my way each month, it will be much appreciated. Read on to find out why.


Any support to keep this site would be appreciated. You could set up a monthly subscription for £2 like some people do or you could pay a one off donation as a gift.
I am not asking you to pay me for other people's articles, this is a clearing house as well as place to put my own views out into the world. I am asking for help to write more articles like my recent false flag gas attack to get WWIII started in Syria, and Trump away from Putin. Hopefully a few missiles won't mean a WikiLeaks release of that infamous video Trump apparently made in a Russian bedroom with Prostitutes. Also please note that this article was written just an hour after the papers came out, and I always come back and update them.

If you want to read JUST my own articles then use the top menu I have written hundreds of articles for this site and I host numerous amounts of material that has seen me the victim of hacks, DOS plus I have been kicked off multiple hosting companies, free blogging sites, and I have even had threats to cease and desist from the US armed forces. Therefore I have to pay for my own server which is NOT cheap. The more people who read these article on this site the more it costs me so some support would be much appreciated.

I have backups of removed reports shown, then taken down after pressure, that show collusion between nations and the media. I have the full redacted 28/29 pages from the 9.11 commission on the site which seems to have been forgotten about as we help Saudi Arabia bomb Yemeni kids hiding in the rubble with white phosphorus, an illegal weaapon. One that the Israeli's even used when they bombed the UN compound in Gaza during Operation Cast Lead. We complain about Syrian troops (US Controlled ISIS) using chemical weapons to kill "beautiful babies". I suppose all those babies we kill in Iraq, Yemen, Somalia and Syria are just not beautiful enough for Trumps beautiful baby ratio. Plus we kill about 100 times as many as ISIS or the Syrian army have managed by a factor of about 1000 to 1.

I also have a backup of the FOX News series that looked into Israeli connections to 9.11. Obviously FOX removed that as soon as AIPAC, ADL and the rest of the Hasbra brigade protested.

I also have a copy of the the original Liberal Democrats Freedom Bill which was quickly and quietly removed from their site once they enacted and replaced with some watered down rubbish instead once they got into power. No change to police tactics, protesting or our unfair extradition treaty with the USA but we did get a stop to being clamped on private land instead of the mny great ideas in the original.

So ANY support to keep this site running would be much appreciated! I don't have much money after leaving my job and it is a choice between shutting the server or selling the domain or paying a lot of money just so I can show this material.

Material like the FSB Bombings that put Putin in power or the Google no 1 spot when you search for protecting yourself from UK Police with "how to give a no comment interview". If you see any adverts that interest you then please visit them as it helps me without you even needing to give me any money. A few clicks per visit is all it takes to help keep the servers running and tag any tweets with alternative news from the mainstream with the #altnews hashtag I created to keep it alive!

However if you don't want to use the very obvious and cost free ways (to you) to help the site and keep me writing for it then please consider making a small donation. Especially if you have a few quid sitting in your PayPal account doing nothing useful. Why not do a monthly subscription for less money instead. Will you really notice £5 a month?