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| Opioid Availability and Consumption in Poland |
| During the last few years, oral morphine has gained ground in Poland as the drug of choice for moderate and severe cancer pain. Before 1991 the total amount of morphine on a single prescription could not exceed 100 mg; in 1995 this was changed to 4 grams per prescription for oral morphine and 8 grams for slow release morphine. In 1998, the total consumption of morphine in Poland was 259 kg, which had risen from 137 kg in 1994; codeine consumption remained fairly stable over the period, from 800 kg in 1994 to 794 kg in 1998.4 Between 1994 and 1998 the average daily consumption of defined daily doses per million inhabitants of opioids was: morphine (486); codeine (622).5 This compares with the morphine daily dose consumption in other CEE countries as follows: Hungary (509); Czech Republic (388); Estonia (216); and Albania (44). |
| The Ministry of Health accepted comprehensive guidelines for pain relief in 1998.6 A programme of pain relief has been adopted that follows the WHO guidelines and also focuses on the training of staff, the availability of medication, and necessary improvements to the system of administration, distribution, and prescribing of analgesics. All opioids used to treat cancer pain in accordance with WHO guidelines (including fentanyl patches and all forms of morphine) are free of charge to patients. |
| The following opioids are registered for use: buprenorphine, codeine, ethylmorphine, fentanyl, methadone, morphine, pethidine and tramadol. Unavailable opioids include: oxycodone (available 2001), preservatives-free morphine sulphate ampoules (available 2002), methodone in ampoules (available 2002) hydromorphone (available 2003).7 |
In February 2002, issues relating to the use of opioids in Poland were summarised by an expert group8 as follows, and an action plan was formulated to address them:
- Does national policy require the use of a special prescription form?
Yes, duplicate form for opioids
- Does the physician or institution have to pay for the special prescription form?
Doctors, no; Institutions, yes
- Does national policy establish a validity period for opioid prescriptions? If so, what amount?
Yes, 30 days
- Does national policy establish a maximum amount that can be prescribed at one time? If so, what amount?
Yes, 10 times the single maximum dose as specified in 1992 Polish Pharmacopoeia
- Does national policy limit the length of time that a patient may be treated with an opioid?
No
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| Average defined daily doses of morphine, Central and Eastern Europe (1994-1998) |
 Source: Clark D, Wright M (2002) Transitions in End of Life Care: Hospice and Related Developments in Eastern Europe and Central Asia. Buckingham: Open University Press |
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