“Vietnam is demonstrating that a developing country can improve accessibility to opioid pain relief even when there is strong sociohistorically-based opiophobia. Important contributors to this progress include strong and consistent leadership at the MOH, consistent and readily available technical assistance from one or more experts in clinical palliative care and opioid policy, sensitivity to the sociohistorical determinants of opiophobia, a modicum of financial assistance, attention to WHO guidelines on balance in national opioid policy, and adoption of the WHO public health strategy for national palliative care programs.”
Moderate or severe pain is common among people with advanced cancer and other life-threatening illnesses. Yet despite agreement that pain relief is a human right, the poorest 80% of the world’s population lack access to strong opioid analgesics. Excessively restrictive opioid policies, especially in developing countries, both stem from and propagate misguided fears about opioids, so-called opiophobia. Because opiophobia, like any norm, is historically, socially, and culturally situated, efforts to change opiophobic policies will be most effective if guided by awareness of their historical, social, and cultural determinants. We describe some of these determinants in Vietnam and report on results of an ongoing project there to allay opiophobia and improve safe access to opioids for medical uses. We used a method that entails working with committed local partners, including a high-level official from the Ministry of Health to review all Vietnamese policies governing opioid accessibility to identify the barriers; devising an action plan to safely reduce or circumnavigate the barriers; obtaining buy-in for the plan from all stakeholders including drug regulators and the police; and assisting the Ministry of Health to implement the plan. Since the start of the project, morphine consumption has increased each year and as of 2010 was nine-fold greater than in 2003, and the number of hospitals offering palliative care has increased from three to 15. We conclude that this “balanced policy method” appears to be helping to reduce barriers to opioid access in Vietnam and should be employed in other developing countries.