Improving palliative care through better access to pain medication in Serbia

Prominent national and international experts on opioid medication, palliative care and harm reduction gathered on 3 October 2013 in Belgrade to identify barriers to access to controlled substances in Serbia and to discuss measures to resolve them. WHO/Europe organized the symposium in cooperation with the conference team of Help the Hospices, a United Kingdom charity, as part of the European Commission’s Access to Opioid Medication in Europe (ATOME) project. The symposium was hosted by the Institute of Public Health in Serbia “Dr Milan Jovanovic Batut”.

Legislation and restricted supply among the most important barriers

Barriers identified in Serbian legislation often relate to the prescription of medicines, penalties and the formulation of provisions in regulations. Only one third of the opioid medication needed to provide adequate treatment in Serbia is available.

Recommended solutions

Working groups formed during the symposium focused on legislation and pain management for palliative care, and suggested several improvements.

• Restrictions on the total amount of opioid medicines prescribed should be removed from current policies, such as that for morphine, for which the upper limit is currently only 200 mg.
• The validity of prescription for opioids should be increased to 30 days.
• Severity and intensity of pain should be the determining factors for prescribing opioid medication, rather than indications or diagnosis.
• Rephrasing current legislation would allow physicians to prescribe more than one opioid at a time, such as a combination of immediate- and slow-release medication.
• A much broader spectrum of available opioids, continuous distribution and better stocking of pharmacies should be arranged, particularly in rural areas.
• Current policies should be revised to sufficiently define palliative care for children, and the strategy on palliative care should include pharmacies.
• Policies of the national health insurance fund should be amended to include coverage of palliative care services.

ATOME project

The goal of the ATOME project is to improve access to opioid medicines for all patients requiring such treatment. The project will present reports on access in all 12 participating countries at a conference scheduled for September 2014.