Dr. Felicia Knaul: Access to Pain Relief Medicines in Mexico Should Be a Priority for Policy Makers

In a commentary published in the February issue of The Lancet Public Health, Felicia Knaul, Ph.D., director of the University of Miami’s Institute for Advanced Study of the Americas and professor in the Miller School of Medicine’s Department of Public Health Sciences, brings awareness to the disparities and crisis in Mexico in accessing opioid medicines for palliative care.

“While the resources required to tackle the pandemic could have not been foreseen, if government officials had made policy changes based on the evidence put forward by The Lancet Commission and Human Rights Watch, they could have been better prepared to facilitate guaranteed access to pain relief and palliative care,” Dr. Knaul said.

In the paper, Dr. Knaul details factors from as far back as 2010 that have contributed to the scarcity of opioid medicines in Mexico, which has led to excess suffering for patients and their families — in a place where the COVID-19 pandemic continues to ravage.

From 2010 to 2013, The Lancet Commission found that Mexico stocked only a third of the opioids needed for palliative care and less than 5% of the opioids required to meet overall need — despite the country being an upper-middle-income country that is widely recognized as a pioneer in universal health coverage.

Largely due to the work of an interinstitutional group, which included representation from the executive and judicial branches of the Mexican government, civil society and academia, the work of the Human Rights Watch, and the launch of the Lancet Commission, the gap between universal health coverage and access to palliative care and pain relief in Mexico rapidly became more apparent. As a result, considerable progress was made on the legislative, policy, and programmatic fronts between 2014 and 2019. The Seguro Popular program, for example, which provided public health insurance for more than 50 million Mexicans and focused on the poorest populations, was a part of that progress, as it included pain relief and palliative care to be provided at primary and secondary levels of care.

A sudden increase in serious health-related suffering

Yet, and despite that progress, in January 2020, Seguro Popular was dismantled, leaving most Mexicans without publicly funded insurance. The closure of the program was also done without establishing a replacement, leaving the health system in a vulnerable state — amid the COVID-19 pandemic. The pandemic caused a sudden increase in serious health-related suffering, resulting in a demand for opioid medicine to relieve pain. The palliative care unit of the National Cancer Institute of Mexico has also shown that as a result of fixed and limited supply of opioid medicines, cancer and other patients have been left in need.

Dr. Knaul´s paper accompanied a major research study by David Goodman-Meza, M.D., M.A.S., assistant professor in the Division of Infectious Diseases at the David Geffen School of Medicine at UCLA, and co-authors, who provided an update on opioid access in Mexico in 2019. To conduct the study, they used novel prescription surveillance data from the Federal Commission for the Protection against Sanitary Risk. The study demonstrated that access to opioid medications increased significantly with the socioeconomic status of the state. When comparing states with very high socioeconomic status with those with very low socioeconomic status, they observed a 10-time higher level of access.

“The innovative analysis by Dr. Goodman-Meza and colleagues demonstrates that the abyss in access across countries is compounded by gross inequities within them,” Dr. Knaul said. “Such analysis should be replicated wherever data are available.

“Going forward, coverage and access to pain relief should be a priority for policymakers to alleviate immediate and future serious health-related suffering. Monitoring access to opioid medicines is essential to ensure that pain and suffering, especially among the poorest populations, is neither ignored nor neglected.”

Written by Amanda Torres

Published on March 9, 2021