The Access to Opioid Medication in Europe (ATOME) project aims to improve access to opioids across the region. Slovakia is one of twelve target countries where academic institutions and public health organisations are working to help governments identify and remove barriers that prevent people from accessing medicines that could improve end of life care, alleviate debilitating pain and treat heroin dependence.
In Bratislava, representatives of the Ministry of Health and civil society – along with physicians from hospice and palliative care, pain management, oncology and harm reduction – met to learn more about the current situation, identify barriers to access and make recommendations for improvement.
Attendees heard from international experts about the concept of palliative care, the current state of palliative care development in the country and the inequity of opioid availability and consumption across the world.
Dr Sheila Payne from Lancaster University introduced the ATOME project, explaining how palliative care development is mapped around the world. She highlighted how Slovakia has moved from classification 3b (generalized provision) to 4a (beginning of integration).
Speakers also included Maria Phelan of Harm Reduction International who spoke about how physicians working in palliative care and harm reduction face similar barriers to accessing opioids, and Dr Elizabeth Mathai from the World Health Organization who referred attendees to the WHO guidelines for ensuring balance in national policies on controlled substances.
Dr Slany, Ministry of Health of Slovakia, explained how public health insurance combined with the constitutional rights of Slovakian citizens to ensure services. Slovakia produces poppy for food as well as morphine alkaloids, which are exported and reimported as pharmaceutical products. When Slovakia became independent from Czechoslovakia, the International Narcotics Control Board advised the Ministry of Health on how to draft model laws for harm reduction and palliative care. Now that Slovakia is preparing to enter the EU, some laws are being redrafted to meet EU standards.
Barriers to access
Slovakian speakers, including physicians and government ministers, discussed access to opioids for both palliative care and harm reduction, and identified the main barriers to palliative care provision as:
- a lack of recognition of palliative care as a specialty and of basic network means that insurance have no duty to make contracts and there are no government-reimbursed services at outpatient clinics
- only pain specialists, but not palliative care or hospice physicians, can write reimbursable prescriptions for strong opioids
- patients in home-based palliative care services have to pay out of pocket if a palliative care, rather than pain physician prescribes
- prescriptions are valid for only five days, with a thirty-day dose limit
- oncologists might not cooperate with palliative care doctors needing to write prescriptions.
Speakers did not identify significant barriers to access to opioids for harm reduction, although some civil society represented cited the geographical constraints of program location and strict compliance issues.
The following recommendations were made during the conference for improving palliative care in the country.
- educate the public about opiophobia
- set up palliative care postgraduate and pre-graduate training in medical schools to train palliative care physicians
- raise status of palliative care by making it a specialty
- increase number of hospice beds around the country.
- reimburse prescriptions written by palliative care and hospice physicians
- support outpatient clinics and reimburse home based palliative care services.
- Prescription limits
- increase validity of prescriptions to seven days with a three month dose limit.