NCDs, Pain, Palliative Care

Morphine, an outcome measure for improved control of NCDs??

As part of the historic UN High Level Meeting on Non Communicable Diseases, the WHO hosted a “Side event” on Targets and Indicators for NCDs. This meeting is soooo important that CNN’s Wolf Blitzer and Sanjay Gupta have been broadcasting live from outside the gates!!  🙂

A “side event?”  Well, this Summit has a plenary session where the leaders of UN member state (country) delegations and other entities (e.g. the International Olympic Committee, the EU) get to talk to a rather empty room. There are also a series of concurrent round tables at which countries and other invited organizations (e.g.INCB, ACS, Livestrong) get to talk about specific topics. One person per country and pretty full. The civil society folks have been given tickets to different sessions of the plenary and round tables: otherwise we are permitted to sit in an “overflow room.” And then there are side events that are fairly open and where if time allows, civil society gets to comment and ask questions!!!!

So this side event was organized under the title “Non Communicable diseases: What gets measured, gets done.” This is a great topic, because not only are we called to action, we are called to make sure this action is effective.

But one of the challenges of many low and middle income countries (LMIC) is their lack of systems to measure outcomes around Non Communicable Diseases. Cancers “cases” are not counted around the world as few countries havel  tumor registries, let alone the ability to measure the number of people with high blood pressure or high blood sugar levels. Epidemiologists do make estimates (or guestimates to the cynical.”

But there is an outcome that we can measure. Opioid consumption!!! In fact the leadership of the INCB told me today that the world has been measuring opioid consumption since the 1930s. Opioid consumption, expressed in either defined daily doses or milligrams of morphine per person consumed in a year (PPSG’s preferred measure) is a metric that we are used to seeing either as country profiles or in a graphical interface.

So with the Declaration stating that palliative care is important (See Palliative Care in the UN Summit on NCDs, a little goes a long way) surely we should measure morphine consumption as an outcome measure. And how could we measure this

  • morphine (mg/person)
  • all opioids, measured as morphine equivalents (mg/person)
  • morphine equivalents/death from Cancer and HIV (mg/death)
  • morphine equivalents/all deaths (mg death)
Each on its own is not perfect and is open to significant debate. For instance why only choose deaths from cancer and HIV. Why not other diseases?  But remember this is a measure of effectiveness it is not an absolute outcome nor restricting who gets therapy. It is a measure!  What are your views on the pros and cons of each of these? Regardless, in some way, Morphine consumption needs to be an outcome measure used to monitor the control of Non Communicable Diseases.
BTW: Identify from which country the speaker in the photograph comes, and I will buy you a beer at the Asian Pacific Cancer Congress in November (OK anywhere but the US if we meet, alright you win even in the US, but if you guess wrong you owe me one!). Leave your answer as a comment.

About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide


One thought on “Morphine, an outcome measure for improved control of NCDs??

  1. I think the country of the speaker is Angola

    Posted by Marta León | September 20, 2011, 9:07 PM

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