The Symposium, held in Vilnius on 19 February, was attended by 53 delegates. This was one of a series of one-day conferences on access to opioids organised through the EC funded ATOME project.
Prof. Sheila Payne, co-director of the International Observatory on End of Life Care at Lancaster University, explained that the revised Atlas of the European Association of Palliative Care (2013) identified the level of palliative care development in Lithuania as being in group ‘3b’, that is: having generalised palliative care provision but with provision not fully integrated into the healthcare system.
Dr Willem Scholten, consultant – Medicines and Controlled Substances, highlighted the gap between the need for and actual use of opioid analgesics in Lithuania: actual use in 2010 was 100kg whereas the amount needed for adequate treatment was identified as 987kg.
Legal barriers to opioid use in Lithuania
Marjolein Vranken of the University of Utrecht outlined findings from a review of national legislation in Lithuania. The review identified barriers to access, including:
- A limitation on the amount of medicines that can be prescribed – this may result in physicians prescribing on the basis of the upper limit rather than on the basis of good practice.
- A limited treatment period which results in patients having to return to the doctor frequently.
Grazina Bobeliene, from the Pharmacy Department of the Ministry of Health, identified additional barriers:
- The use of special forms for the prescription of opioids – each practitioner is given only 10 forms at one time. Delays in obtaining additional forms can result in practitioners being unable to prescribe to patients in need.
- Opioids can only be prescribed by pharmacists with a special license.
Prof. Dalia Skoropskiene, from the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos, highlighted barriers in other areas such as: lack of education and training for physicians, stigma around use of opioids for pain management and fear of drug dependence.
The following recommendations were made by conference delegates in relation to the use of opioids in pain management:
- Make immediate release analgesics such as liquid or inhalatory formulations, which are currently unavailable, available to practitioners.
- Extend reimbursement of costs to medicines that are used for the treatment of breakthrough pain.
- Revise restrictions around the prescription and storage of opioids in hospitals. This would, for example, allow qualified nurses to prescribe these medications.
- Improve the current process for the issuing of prescription forms for opioids, specifically to make it less bureaucratic and time-consuming.
- Address issues relating to the prescription of analgesics for non-cancer patients.
The next ATOME conference will be held in Slovakia on 25 March.