ACCESS TO OPIOID MEDICATION IN EUROPE (ATOME)

The ATOME project aims to improve access to opioids across Europe. A consortium of academic institutions and public health organisations is working to help European governments, in particular in Eastern Europe, to identify and remove barriers that prevent people from accessing medicines that could improve end of life care, alleviate debilitating pain and treat heroin dependence.

WHY THIS PROJECT?

About 1.7 million people in Europe die from cancer each year, many experiencing severe pain, even though effective pain medications exist. Launched in February 2010 in Aachen, Germany, and co-led by the University of Aachen, Lancaster University (UK), and the World Health Organization (WHO), the Access to Opioid Medication in Europe (ATOME) project will address the legal, administrative and organisational barriers that impede access to pain management for treatment of cancer and other conditions in many European countries.

We have made great progress in pain management in the last decade, and nobody ought to suffer from pain, but still patients are dying in terrible pain, without a chance to get morphine. Our new project aims to work closely with policy makers and doctors in 12 countries to remove legal barriers to access to morphine and other opioids.

Professor Lukas Radbruch, Chair of Palliative Medicine of the University Hospital Bonn
President of the European Association for Palliative Care

There is great variability across European countries in terms of legal controls of morphine and other opioids. This means that in some countries it is very difficult for doctors to prescribe pain management medicines. In other cases, physicians may be unfamiliar with prescribing this special class of medicine. As well, misperceptions around opioids and dependence can limit access for both pain management and treatment of drug dependence.

AIMS & GOALS

The overall goal of this project is to undertake applied research into the reasons why opioid medicines for moderate to severe pain and for the treatment of opioid dependence are not used adequately in 12 European countries, and to elaborate and disseminate tailor-made recommendations to each country for improving the accessibility, availability and affordability of controlled medicines, and disseminate these to governments, health-care professionals, other key decision-making bodies as well as to the general public.

The overall goal will be implemented through three specific objectives.

Specific objective 1:To undertake a national situational analysis in 12 European countries with regard to access to controlled medicines, including their availability, rational use, and causes for underuse; and to make recommendations to their national governments for improvements.

Specific objective 2: To undertake an external review of relevant national legislation in 12 European countries and recommend, in compliance with the international drug conventions, appropriate amendments to governments in order to improve access for legitimate and rational use of controlled medicines.

Specific objective 3: To elaborate and introduce a research and monitoring tool for tracking and comparing the extent of opioid availability in the 12 target countries.

With a commitment of 2.45 million Euro over five years from the European Commission's 7th Framework Programme, the ten ATOME partners will work with the country teams, including government officials and public health and medicines experts, to carry out legislative and policy reviews, leading to recommendations that will facilitate access for all patients requiring treatment with medicines controlled under the international drug conventions.

This is in line with our ongoing work to improve access to these medicines worldwide. The potential benefits of this partnership extend well beyond palliative care. For example, there are around 3.7 million people who inject drugs in Europe, but only a minority has access to methadone therapy. Such therapy not only helps them manage their dependency, but also helps their social re-integration and prevents them using ‘street drugs’ which increase their risk of harm and lead to infections like HIV from needle sharing.

Willem Scholten, of the WHO Access to Controlled Medicines Programme

This is a very exciting project that will make a real difference to patients with cancer and their families and will help them to cope with the disease, enabling them to live their life without pain until the very end.

Professor Sheila Payne, Director of the International Observatory on End of Life Care at Lancaster University

HOW IT WORKS

The work in the ATOME Project follows two tracks in parallel.

One track is related to the analysis of national policies and national circumstances that affect the accessibility and availability of the medicines involved. The goals are both to make recommendations to the government and to make professionals aware of problems arising from their professional practice, by undertaking a national situational analysis with regard to controlled medicines, including their availability, rational use and causes for underuse. Furthermore, in this track a plan will be drafted on how the implementation of these recommendations can be promoted at country level.

The other track looks at optimising the relevant legislation in order to acknowledge both the prevention of abuse and dependence and the medical need for these medicines. The goal is to make recommendations on how to optimise the legislation for equal or even better prevention of abuse and dependence and making the medicines concerned readily available and accessible for rational medical use at the same time.

These are the countries that ATOME will focus on: