Friday , May 20 2022

Obstacles to the treatment of pain and addiction: the other victims of the war with drugs


The policy against the use of psychoactive substances affects the health of thousands of patients who need opioids to calm their pain or treat their addiction to heroin. The Deaustroy investigation has explored how stigma for these drugs has created barriers to these populations in Colombia.

According to the study, while the drug control system spends $ 100,000 million to implement the global ban, $ 145 million would be enough to close the gap in opiate access in low- and middle-income countries.Pxhere

"I went into treatment more than ten times. I was in prison for a while, and the worst part of my consumption was after; I was alone (…) I finally arrived at the program. The abstinence syndrome is terrible. I had the first 24 hours without methadone and air conditioning at all, ice cream. They gave me a lot of drugs – synchon, haloperidol, beannel and who knows more – and I said "give me liberty." I left her in despair (…). From the worry, after three weeks I spent $ 700,000 on drinks, marijuana and cocaine. (Read this is the "irreplaceable" group in the world of medicines in Colombia)

The previous story is from Colombian. His age and his name are not certain. Your city too. He or she was or was a heroin user, and his words reveal a problem that very few people want to talk about: the difficult experiences faced by addicted people when they want access to health services to alleviate their suffering. This is an accumulation of barriers that spread across the country and that the Dejusticia organization has condemned an investigation, presented yesterday evening. The paths of pain. Access to palliative care and treatment of heroin use in Colombia, as it was called by the authors, shows the complicated path that these consumers have to travel, and another group that little by little began to gain a place in the discussions of the medical world: those approaching the end of life and demanding so-called palliative care . (Read "Colombia can not pay for drugs at any price")

Although these two groups do not appear to share elements, according to Isabelle Pereira, a political scientist and author of the document, along with Lucia Ramirez, it is crucial that they coincide: common opiate deficiencies, those drugs derived from poppy that are crucial importance for the treatment of pain and, in the case of methadone, for the treatment of heroin withdrawal syndrome.

Codeine, tramadol, morphine, hydromorphone, fentanyl, oxycodone, tapentadol and buprenorphine are one of the most popular drugs classified in this category. As described several times in this newspaper, this is a strange paradox: while countries such as the United States suffer an epidemic because of excessive consumption (42,000 deaths were caused in 2016), others such as Colombia have extremely limited access . In other words, this means that today many people, even if they do not want to, have to live with pain.

In figures: while the world's average morphine consumption is 62.4 mg in 2015, in Colombia it was barely 17 mg. The addition of global statistics, the stigmatization of these drugs, shows that 5 000 million people live in countries where there is no access to pain relief medicines and that every sixth person with psychoactive substance dependence can not access treatment.

After studying the scientific evidence of opiate use, conducting 103 interviews with multiple participants and a detailed study of the cases of five cities (Kali, Santander de Kilica, Armenia, Pereira and Kukuta), Pereira and Ramirez found that this population should overcome many obstacles to receive adequate attention. It is impossible to sum up in a few paragraphs the difficulties they have reduced to 200 pages, but Pereira believes that this debate has missed a key issue: the negative effects that drug policy has on the health of thousands of people. patients.

In other words, this reveals another complicated paradox: "While international policy has focused on securing a" drug-free world "through criminalization, eradication and law enforcement, it has not done much to provide a world of medicines accessible to those that they need medical use, "they write in the book.

The sum summarizes the difference. While the drug control system spends USD 100,000 million to implement the ban at a global level, $ 145 million would be enough to close the opium gap in low and middle income countries.

In Colombia, those who want access to methadone treatment for the consumption of psychoactive substances should travel on a complicated route. The shortage in some cities, the restrictions on health care staff, the lack of mental health services, the enormous moral prejudices of the doctors treating them, the cruel and inhuman treatment that worsens the withdrawal syndrome and the lack of follow-up for those seeking professional help, are some of the problems they face.

The consequences? In some cases, they have to resort to the illegal market to find methadone. In others, they prefer to distance themselves from this health service and from those professionals who have not yet managed to get rid of stigma and treat treatment as a new addiction.

According to Pereira, "unlike what happens to patients who require palliative care, who usually have more empathy because they are at the end of their lives, healthcare professionals do not feel obligated to treat users heroin ". This is a point that reveals a social discussion about what we take as a disease, he says.

The debate, on the other hand, is also complicated: why are there still people who can not alleviate the pain? Is not the transit at the end of life a path where there is no suffering? The answers seem obvious, but the reality is different. Although the use of morphine, one of the most commonly used opiates, has grown in Colombia (see the table), many regions have no access to these drugs. The obstacles are varied: the lack of doctors' education, the many problems in the long chain of distribution and the absence of some opiates in the aid plan are some of those mentioned. Pereira adds another: the stigma to which the media usually contribute when they import, under scandalous headlines, problems like the US or Africa epidemic when dealing with completely different realities. In her eyes, Lucia Ramirez, her research should contribute to this: to expand the way we think in our country, drug addiction and the end of life.

source: The paths of pain. Access to palliative care and treatment of heroin use in Colombia,

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