Time to act for reappraising the educational system for universal access to opioid analgesics, for quality palliative care and cancer-related pain relief in East Asian countries

Abstract

h 2 Pain is one of the most common symptoms among patients ith cancer. Pain significantly debilitates cancer patients’ healthelated quality of life (QOL), and it can persist as one of the inependent prognostic factors for survival. When the World Health rganization (WHO) recently reformed the International Classifiation of Diseases, “cancer-related pain” was appended to be dened as chronic pain attributable to either the cancer itself or ts treatments. Opioid analgesics are critical to the effective reief of cancer-related pain. Opioid analgesics were originally recmmended by the WHO in 1986 as part of the cancer pain reief guidelines for improving QOL among patients with cancer. Furher, the WHO in 2018, extended the indications for strong opiids from conventional moderate-to-severe cancer-related pain to nclude mild-to-moderate cancer-related pain. Thus, the adminisration of opioid analgesics has persisted as a mainstay analgesic herapy for cancer-related pain. To expand universal access to efective palliative care and cancer-related pain relief, the problem f supply has been identified as one of the barriers for adequate pioid availability by the International Narcotics Control Board. 1 In The Lancet Regional Health – Western Pacific , Wu and coleagues 2 report important findings from a retrospective, nationide database study investigating annual opioid prescription paterns from 2012 to 2017, in which internationally-recommended trong opioids such as oxycodone and hydromorphone were inroduced in Taiwan in late 2014. Prior to the introduction of hese strong opioids, morphine and transdermal fentanyl were only vailable as guideline-recommended strong opioids in Taiwan. The uthors demonstrate that use of both strong opioids (transdermal entanyl and morphine) and weak opioids (tramadol, buprenor-