Global Opioid Policy Initiative: Next Steps

Use the 10-point plan to get your health authorities to take action to reduce the excessively restrictive barriers that currently limit access to opioid analgesics.

Taking GOPI to a political level: the 10-point plan

1. Education
   Governments will review the curricula for undergraduate and postgraduate education so that all newly-graduating healthcare professionals understand the legal requirements and have the knowledge and skills to use opioid medications in the relief of cancer pain appropriately and safely as an integral part of high quality care.
2. Formulary restrictions
   The GOPI initiative endorses the standards of the WHO Essential Medicines List as a minimal standard for opioid formulary. This minimal formulary should include oral codeine, immediate-release morphine, controlled-release morphine tablets and injectable morphine.
3. Physician prescribers
   All physicians with a ‘license to practice’, or its equivalent, issued by the appropriate professional or registration body can prescribe pain medication. Beyond this, good practice guidance will be strengthened to make clear that prescribers should not prescribe beyond the limits of their competence and experience.
4. Patient restrictions
   Cancer patients suffering from strong pain should be able to receive a prescription for opioid analgesia without the requirement for a special permit or restrictions on care settings where opioids can be prescribed.
5. Prescription limits
   Governments will issue guidance making clear that single prescriptions for opioids should normally be limited to a supply of 28/30 days, unless exceptional circumstances (such as a patient travelling abroad) require this time to be extended.
6. Prescription forms
   The requirement for special prescription forms is not considered an excessive burden per se. It is essential, however, that forms be readily available to prescribers and that the process of procuring them not be excessively burdensome so as to provide a disincentive to do so.
7. Pharmacists
   Pharmacists should be allowed to correct technical errors in controlled drug prescriptions either in consultation with the prescribing physician or, if the physician cannot be contacted, when the pharmacist is confident that the intention of the prescribers is clear.
8. Monitoring of prescription forms
   Where possible central monitoring is a helpful strategy in identifying abusive behaviors.
9. Emergency prescribing
   Regulatory provision should be made for emergency prescriptions of opioids for patients in severe pain who cannot obtain a physical prescription.
10. Supplementary prescribers
    Non-physician-prescribing by specially trained nurses and pharmacists is advocated as a means of providing a backup system of prescribing in situations when there is no physician availability.