A Different Kind of Opioid Crisis

In the United States, we are familiar with the opioid crisis that is ravaging the country. Most of the world does not have proper access to opioids for medical needs. In particular, cancer patients do not have access to these medications that treat their pain as a result of their condition. Of the 298.5 metric tons of morphine-equivalent opioids distributed in the world per year, only 0.1 metric ton is distributed to low and middle-income countries (LMICs).

Pain Management in Mexico

Mexico has made great strides to provide better palliative care for their citizens, and yet, when it comes to pain management, they have one of the lowest levels of morphine-equivalent consumption in South America.

Below are some key developments in health care reform in Mexico so far that have affected pain management:

What are the barriers that continue to undermine effective pain management in Mexico?

• Less focus on treatment and prevention of non-communicable diseases
• Lack of access
• Morphine is a part of Seguro Popular, but not many doctors are able to prescribe it for various reasons
• A low supply of oral morphine throughout the country
• Lack of insurance
• Many Mexicans remain uninsured and Seguro Popular is not comprehensive enough to provide necessary treatments
• A limited knowledge of opioid use among patients and health care practitioners
• Results in opiophobia (a fear of prescribing opioids due to their possible misuse and addiction) and an incorrect understanding of their efficacy
• Lack of training
• Not many of the universities in Mexico include courses in palliative care. Of 111 government-certified doctor training programs in the country, only 17 programs offer courses in palliative care as part of  medical education
• More focus on preventing non-medical use of opioids without considering the right to access medicines to relieve pain
• Most of the heroin available in the United States comes from Mexico and Colombia and the production of heroin in Mexico continues to rise
• Cost
• The price of injectable morphine purchased in the public sector in late 2014 was many times higher than the lowest reported international price and exceeded the highest international price

Proposed Solutions

Mexico is at the forefront of most LMICs regarding palliative care reform. Despite the improvements to the health care system, there are several barriers that have hindered effective pain management for those who need it most. Adding mandatory courses on palliative care as part of medical and nursing training programs would allow for more expanded access and would make sure there is proper, well-informed distribution of care especially in regard to prescribing opioids. In general, there needs to be more availability of care and medications outside of urban centers.