1) The Life Before Death feature film premiered in Singapore on February 1st. This movie about the international pain crisis accompanies 50 short films (33 have been released on YouTube so far), a one-hour TV documentary (not yet released), and two advocacy websites (here and here). If you are interested in hosting a screening of the feature film in your area, click here. (Previous related posts are here, here, and here.)

2) The Morphine Manifesto has been released by Pallium India, the International Association for Hospice and Palliative Care (IAHPC) and the Pain & Policy Studies Group /WHO Collaborating Center at the University of Wisconsin. You will recognize many of the launching partners in palliative medicine and other important organizations who have a strong interest in the treatment of pain, like the American Cancer Society, LIVESTRONG, and Human Rights Watch. It basically calls on governments, pharma, and health care institutions to guarantee affordable access to oral immediate-release morphine. If there are already more expensive opioid formulations in countries, it demands that immediate release oral morphine also be made available. 

This is extremely important because many countries have supplies of injectable morphine, fentanyl patches, and sustained-release morphine before they have oral immediate release morphine available. Not that having the other medications is bad. However, not having safely-titratable, inexpensive opioids that can be given easily in the inpatient and outpatient settings is a HUGE problem in many countries. For instance, they may have fentanyl patches or extended release morphine, but no immediate release, which makes safe titration more difficult and costly. Cost matters because in low resource countries, the more expensive it is, the fewer people you can treat with it and many will get no treatment at all. Injectable morphine is also an important drug, but without oral immediate release morphine, outpatients have little hope of getting medication for severe break-through pain. Take a look at the list of supporting people and organizations. Are you surprised at the number of hospice and palliative medicine organizations now? We are gaining a voice all over the world! 

(Previous related posts are here and here.)

3) The Drug Shortage Prevention Act (HR 3839) sponsored by Congressman John Carney (D-DE) and cosponsored by Larry Bucshon (R-IN) was introduced on Jan. 31st. See the announcement info from Carney's website. If you aren't worried about drug shortages, you should be. There were over 230 of them last year in the United States. THE UNITED STATES! (I'm only half kidding in my feigned incredulity.) You've probably seen the media coverage of chemotherapy and other drug shortages and the gray market trade of medications (here's a link to a story from last year from PBS).  Eye opening and worrisome to me is that drugs I have thought of as "common" are having serious shortages as well. Two recent examples of severe shortages I know about because of having to change my practice to deal with them are parenteral dexamethasone and parenteral midazolam. Christian recently posted on the shortages, with a great link from the American Society of Health-System Pharmacists for a list of current drug shortages. I looked at it and was shocked because all of the commonly used opioids are on the list because of shortages of at least one concentration or tablet size. Granted, many of the medications listed have lot of other concentrations or tablet sizes available, but some drugs on the list do not. Many medications only have one or two manufacurers.

The bill has been referred to the House Energy and Commerce Committee and the Judiciary Committee according to Library of Congress THOMAS website (put in under Bills "HR 3839"). You can find out if your representative sits on either of these committees with an easy to use website with info on who is on the committees at govtrack.us. The text of the actual bill is not available yet, but do you think this is a reasonable approach to deal with this very real and growing problem? If not, what do you think would help make sure that we have access to the medications our patients need?

Stand up to cancer by advocating for access to medications in the US and around the world!