It is with great pleasure that we share some recent successes of the Pain and Policy Studies Group’s International Pain Policy Fellowship (IPPF). The principal goal of the IPPF is to develop national leaders from low‐ and middle‐income countries (LMICs) and empower them with the necessary knowledge, skills and guidance to improve the availability and accessibility of opioids for the treatment of pain in their countries. To date, four cohorts have been selected, resulting in 31 fellows from 25 countries.
The progress achieved by Fellows has been highlighted in multiple articles in recent years – especially that of Colombia. In collaboration with the PPSG, her mentor Liliana De Lima, and myriad dedicated colleagues, Dr. Marta Leon, a medical oncologist, has been successful at initiating collaboration with relevant governmental bodies, national authorities and professional societies to improve the distribution of opioids in Colombia, opioids that are approved and should be readily available.
While Morphine was available in Bogotá (albeit meagerly), Dr. Leon learned it was a much different story outside the capital city after she’d conducted a survey of regulators and health care providers about opioid availability in their regions of the country. The various reasons included pharmacies that stocked opioids having strange schedules or limited hours, while some only stocked one type of opioid.
Motivated by the steps she laid out in a National Action Plan during her Fellowship training, and supported by Lilliana and PPSG staff, Dr. Leon convened a workshop which brought together all of the players involved in the opioid chain of distribution, including representatives from the Ministry of Health, national and state authorities, physicians working in pain & palliative care, and international experts. As a result of her work and the willingness of regulators to listen and act, each state in Colombia now has at least one pharmacy that dispenses opioids 24/7. Furthermore, the Ministry of Health has added additional opioids (methadone, hydromorphone, and morphine solution) to its National Obligatory Health Plan available at no cost to patients.
Step Two of her Action Plan involved education. Dr. Leon used results of another survey she conducted on medical students to determine their knowledge and attitudes about pain management and palliative care to convince the Universidad de la Sabana to implement a mandated course about these topics. Online coursework and continuing education in these topics has also been implemented. Hundreds of medical students who attend the Universidad de la Sabana have now taken advantage of these courses.
Step Three included development of a palliative care law. Dr. Leon was a member of a working group invited to advise two senators who were working on the development of a palliative care. A draft was revised multiple times and went through many links in the approval process. After more than 6 years, it is a pleasure to report that the Colombian Palliative Care Law (Law 1733) was approved and signed on 8 September 2014. Article # 8 of the Law contains language regarding controlled medications and their mandate for 24/7 availability.
While we realize these steps won’t solve all problems in Colombia related to opioid availability and pain relief, they are definitely a step in the right direction and we congratulate Dr. Leon on these successes. We look forward to sharing more stories in the upcoming weeks regarding achievements from other Fellows.