Graph 2 shows the average daily consumption of Defined Daily Doses (DDD)¹⁰ of morphine per million inhabitants during the years 1994-1998 for South American countries according to the world requirement estimates for 2000 of the International Narcotics Control Board (INCB) (Statistics for 1998). ¹¹

 

Graph 2.
Average daily consumption of DDD of morphine per million inhabitants in countries of South America for the 1994/1998 period. Global consumption of principal narcotic drugs International Narcotics Control Board (2000) Narcotic Drugs: Estimated World Requirements for 2000. New York: United Nations.

 

According to these figures, Colombia is third in South America after Argentina and Chile on DDD of morphine. The average daily consumption of DDD of morphine per year has been suggested as an indicator of adequate pain relief and palliative care developments in the country¹².

In 2002, results of a nationwide survey conducted amongst Colombian medical practitioners during 1996 showed that 67% of the consulted doctors considered their education on cancer pain treatment to be insufficient; 46% identified pharmacies’ poor availability of opioid as a problem for outpatients in need of the medicine; 34% found difficulties in achieving an adequate analgesic dose to control their patients’ pain; 18% considered opioid addiction to be a major problem amongst their patients and 93% judged the pain of their patients to be moderate or severe despite having received treatment¹³. According to this study, the following factors were the most influential in prescribing practices: postgraduate education, specialist training, basic medical education and personal clinical experience. In the same study, the availability of opioid for medical practice was acknowledged to be a particularly sensitive issue in a country highly affected by the illicit traffic and the black market of drugs.

Dr Restrepo describes progress made and barriers still to be overcome in making opioids more accessible to patients:

“In many cities it was very difficult [to obtain opioids] and from Bogotá [opioids] had to be sent [to other cities in the country]. But not all hospitals had the opportunity to make their opioid requests on time. In terms of opioid distribution, this has been improved. Unfortunately, concerns about illicit traffic and the misuse of these medicines have meant that suddenly we have to have further restrictions. Currently, for instance, each time a physician prescribes an opioid, the National Fund rings the doctor to confirm that such formulation was prescribed by such physician; and this makes things rather difficult for patients”¹⁴

Dr Moyano, on the other hand, describes patients’ preferences and attitudes towards the use of opioids:

“A big percentage of our patients are scared of opioid addiction despite explanations and educative campaigns. There are, for instance, and reaching almost one hundred per cent of patients, who are frightened of becoming addicted to morphine. There is a sort of “morphino-phobia” which is different from the general “opioid-phobia”. Other opioids are better tolerated, possibly because there is not much information and also because with them there is not the same historical legacy that exists with morphine. Definitively, fentanyl patches are much better accepted because they [patients] see them somewhat different, possibly because of its system of delivery”¹⁵

Dr Rene Rodríguez describes his experience as follows:

“Very often, as it is happening now, we have deficits on available opioids. At this moment, and for more or less three months now, we cannot get morphine in the city of Cali; neither hydromorphone or methadone which are the potent opioids we usually use. We have got legal problems. Morphine, for instance, can be prescribed for only ten days. And this is a very difficult issue when patients live far away from the health centre. Patients who live two or three hours from Cali have to send a relative every ten days to look for opioids”¹⁶