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• W2079136612 abstract "It is estimated that millions of patients with cancer worldwide experience moderate to severe cancer pain. Unrelieved cancer pain continues to be a major public-health concern, despite available treatment. The use of opioids is the cornerstone of cancer-pain management. Misguided national health policies, nonavailability of drugs, and inadequate education of physicians and the public are the main barriers to the prescription of opioids. The trend of increasing medical use of opioids to treat pain does not seem to be contributing to increases in the health consequences of opioid analgesic abuse.1Joranson DE Ryan K Gilson AM Dahl J Trends in medical use and abuse of opioid analgesics.JAMA. 2000; 283: 1710-1714Crossref PubMed Scopus (426) Google Scholar In many European countries, governments and legislators have been restrictive about the use of opioids.2Zenz M Willweber-Strumpf A Opiophobia and cancer pain in Europe.Lancet. 1993; 341: 1075-1076Abstract PubMed Scopus (166) Google Scholar In Italy, restrictive prescribing regulations emerged as the most important barrier to adequate pain management by family physicians.3Minotti V Betti M Attitudes of Italian general practitioners in the treatment of cancer pain: the Committee of the Associazione Italiana Oncologia Medica.Tumori. 1997; 83: 729-731PubMed Google Scholar In February, 2001, the Italian government approved a law aimed at facilitating opioid prescription for cancer pain. It seems less restrictive and would potentially have improved the prescription. We calculated, for the existing opioids commercially available in Italy used mostly for cancer pain, the amount sold 6 months before approval of the new law and 6 months after, to assess changes in the attitudes of Italian physicians in prescribing opioids. Data are presented in the table. Morphine has been marketed as a slow-release preparation by two pharmaceutical companies. We did not take methadone into consideration, since it is used for drug-users’ detoxification.TableOpioid use in mg per person in general population sold before and after change in opioid prescription lawBeforeAfterOpioids0·220·22Transdermal fentanyl0·00050·0054Morphine 1*From two different anonymised companies.0·19040·0074Morphine 2*From two different anonymised companies.0·02400·1785* From two different anonymised companies. Open table in a new tab By contrast with what was expected, opioid consumption did not increase after the approval of the new law. Sales of only one preparation, more introduced into the market after the law's approval, rose sharply to increase in its selling. Morphine consumption, as a sustained release formulation, substantially decreased. Therefore, freedom of prescribing should not be seen as automatically leading to increases in opioid consumption. This has been probably considered an alibi for many years. Lack of knowledge, ignorance, patient-related barriers, fears about addiction, and failure to educate doctors and other health-care workers by national governments in cancer-pain management remain the major reasons for unsatisfactory treatment. The difficulty of under-education of physicians about pain assessment and management should be solved by the integration of relevant postgraduate training programmes." @default.
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• W2079136612 date "2002-10-01" @default.
• W2079136612 modified "2023-09-27" @default.
• W2079136612 title "Opioid prescription in Italy: new law, no effect" @default.
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• W2079136612 doi "https://doi.org/10.1016/s0140-6736(02)11261-x" @default.
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