Appropriate access to opioid medicines: A legal & policy perspective

Opioid medicines are an essential pharmaceutical treatment option. However, tension exists between access and control. Within this context, governments and policymakers have a dual obligation: ensuring access for patients in medical need while preventing harm associated with non-medical and inappropriate use. Although this dual obligation exists, it is difficult to find the right balance when it comes to achieving maximum health outcomes. In the United States, and in other high-developed countries including the Netherlands, concerns exist about increased opioid analgesic use.

Our thesis aimed to study which factors may have a negative impact on access to opioid medicines. We focused on twelve central and eastern European countries with statistical evidence of inadequate consumption of opioids, and on legal and policy aspects. We identified many potential barriers to appropriate access in legislation and regulations. Additionally, a variety of barriers was reported by several relevant stakeholders. We did not find a correlation between the number of legal potential barriers and access to opioid analgesics. Apparently, other factors may play a critical role. Very little is known on the complex interplay of all factors that determine appropriate access to opioids.

We suggest an approach that includes removing obvious impediments to appropriate access in legal and regulatory documents that do not contribute to the prevention of non-medical use. We also propose the implementation of medical treatment guidelines and policies that promote the safe and appropriate prescribing of opioids based on solid scientific evidence. This should go in parallel with educating healthcare professionals, patients and policy makers to promote the safe and rationale use and equally important to avoid the stigmatization of legitimate opioid use. Finally, it is important that a more balanced view is presented in the media and in scientific literature.