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Alexander DeLuca, M.D.
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White Paper on Opioids and Pain: A Pan-European Challenge

Report compiled by OPEN Minds, Opioid and Pain European Network of Minds; 2005-06. Posted: 2005-06-22; Modified: 2005-09-01.
[Source= http://www.openmindsonline.org/SectionWhitePaper/wp1_foreword.asp?id=1102]

Related resources:  
Pain and Opioid Therapy archives  ;  War on Docs Academic, Legal, Official archives 
See also:
Chronic Pain: I - A New Disease?  ;  II - The Case for Opiates -
Daniel Brookoff; Hospital Practice; 2000
The Role of Opioids in Cancer Pain Management
- M. Fukshansky, M. Are, A.W. Burton; Pain Practice, 5(1), page 43; 2005 
Principles of Opioid Management of Pain - Joel Hochman and members of NFTP and PRN listServ; Summer 2006
WAR ON PAIN SUFFERERS Special Collections - Introduction and Table of Contents
War on Doctors and Pain Crisis Weekly - RSS feed:
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[Full Text of this Report in Adobe PDF format (566.86 KB)]


The recent history of opioid use in chronic pain is one of progress, of the gradual increase in understanding by doctors of their efficacy and safety, government changes to the restrictions affecting their use and improved access by patients.

However, policies regulating strong opioids are usually aimed at limiting criminality, abuse and addiction. They often restrict the use of opioids by physicians, limiting access to pain relief. Although international narcotics control treaties from 1961 dictate that national policies recognise that opioid analgesics are necessary for the relief of pain and suffering, many national laws do not. The reputation of strong opioids has been damaged by a singular “war on drugs” emphasis aimed only at their potential for abuse.

In 1969, the World Health Organization (WHO) abandoned its interpretation that medical use of morphine inevitably results in addiction. The WHO clarified that tolerance and physical dependence by themselves do not constitute 'drug dependence', a diagnosis which is characterised primarily by compulsion to use drugs and persistent use despite harm.

Another turning point came in 1986, when the WHO began its global initiative to relieve pain caused by cancer using a three-step approach that required the use of opioid analgesics like morphine. The WHO ‘pain ladder’ distinguished between strong and weak opioids and established clear roles for them in treating pain.

The management of cancer pain began to improve, and this in turn precipitated a scientific and clinical reappraisal of the use of opioids for chronic non-cancer pain.

Since then, opioids have become more widely accepted and used by both general practitioners and specialists. The International Association for the Study of Pain (IASP) has furthered understanding of the appropriate use of opioids and organisations such as the British Pain Society and Amsterdam Group have developed Guidelines on their optimal use.

Nevertheless, as this White Paper reveals, in some countries outdated rules and regulations remain, continuing the legacy of past attitudes when fear about opioids prevailed. This is a crucial point as it illustrates that what is required in Europe above all is a straightforward process of updating, of spring cleaning the numerous rules and regulations that are identified in this White Paper.

This process should be directed by the guiding principle of balance, as proposed by the WHO*. Governments should control and monitor the consumption of opioid medicines, but should also ensure that patients have access to them, and doctors can prescribe them, without undue inconvenience or stigma.

Even when outmoded laws are gone, outmoded perceptions remain, and these must be corrected by a combination of communication, leadership and education.

In its recent reports, the International Narcotics Control Board (INCB) has congratulated governments, particularly in Europe for improving access to the medicines required for pain management. As this White Paper shows, however, there is still much work to be done.

* http://www.who.int/medicines/library/qsm/who-edm-qsm-2000-4/who-edm-qsm-2000-4.shtml  

[Full Text of this Report in Adobe PDF format (566.86 KB)]



Dr. DeLuca's Addiction, Pain, and Public Health website

Alexander DeLuca, M.D., FASAM

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Originally posted:  2005-06-22

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