Palliative care patients and their families in Uganda, like elsewhere in the world, are very vulnerable; not only physically but also socially, culturally, psychologically and spiritually. Many health workers are ill-informed about legal issues and palliative care workers often do not have adequate legal training, or a network of support to draw on for legal advice for their patients. Many palliative care programmes lack multidisciplinary teams with legal capacity.

In 2009, the African Palliative Care Association (APCA), in collaboration with the Open Society Foundations' Law & Health Initiative, International Palliative Care Initiative (IPCI) and Open Society Institute for East Africa (OSIEA), reviewed laws and practice guidelines in Kenya, Uganda and Tanzania related to the legal needs of palliative care patients and their families.

The group undertook a rapid appraisal among legal practitioners, policy makers, palliative care providers and patients in Kenya and Uganda to identify their understanding of the legal and human rights issues that hinder palliative care provision.

The review and appraisal identified some of the legal and human rights barriers that affect the advancement of palliative care, particularly the availability of medications.

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Development of legal and human rights guidelines for palliative care in Uganda

Opioids are potent respiratory depressants, and overdose is a leading cause of death among people who use them. Worldwide, an estimated 69 000 people die from opioid overdose each year. The number of opioid overdoses has risen in recent years, in part due to the increased use of opioids in the management of chronic pain. In 2010, an estimated 16 651 people died from an overdose of prescription opioids in the United States of America alone.

Opioid overdose is treatable with naloxone, an opioid antagonist which rapidly reverses the effects of opioids. Death does not usually occur immediately, and in the majority of cases, overdoses are witnessed by a family member, peer or someone whose work brings them into contact with people who use opioids. Increased access to naloxone for people likely to witness an overdose could significantly reduce the high numbers of opioid overdose deaths. In recent years, a number of programmes around the world have shown that it is feasible to provide naloxone to people likely to witness an opioid overdose, in combination with training on the use of naloxone and the resuscitation of people experiencing opioid overdose, prompting calls for the widespread adoption of this approach. In 2012, the United Nations Economic and Social Council (ECOSOC) called upon the World Health Organization (WHO), in collaboration with the United Nations Office on Drugs and Crime (UNODC) to provide advice and guidance, based on scientific evidence, on preventing mortality from drug overdose, in particular opioid overdose.

While community management of opioid overdose with naloxone is expected to reduce the proportion of witnessed opioid overdoses which result in death, it does not address the underlying causes of opioid overdose. To further reduce the number of deaths due to opioid overdose other measures should be considered, such as:

curbing innapropriate opioid prescribing;

curbing inappropriate over-the-counter sales of opioids;

increasing the rate of treatment of opioid dependence, including for those dependent on prescription opioids.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Community management  of opioid overdose 

Opioids are psychoactive substances derived from the opium poppy, or their synthetic analogues. Examples are morphine and heroin.

Worldwide, an estimated 69 000 people die from opioid overdose each year.

There are an estimated 15 million people who suffer from opioid dependence (i.e. an addiction to opioids). The majority of people dependent on opioids use illicitly cultivated and manufactured heroin, but an increasing proportion use prescription opioids.

There are effective treatments for opioid dependence yet only 10% of people who need such treatment are receiving it.

Due to their pharmacological effects, opioids in high doses can cause respiratory depression and death.

The inexpensive medication naloxone can completely reverse the effects of opioid overdose and prevent deaths due to opioid overdose.

WHO information sheet on opioid overdose

The Hepatitis C Coalition has established eight calls for tackling hepatitis C. We need everyone to play their part in eliminating the virus.

There is an unprecedented opportunity to improve services and outcomes for people with the virus significantly. The new NHS and public health commissioning environments can be used to drive improvements and, if advances in cost-effective treatments are matched by improvements in service delivery, the elimination of hepatitis C from the UK is achievable.

Seizing this opportunity requires strong national leadership, co-ordination and oversight.

Ministers and political parties to commit to halving hepatitis C related liver cancers and deaths by 2020 and eliminating the virus by 2030

The Department of Health to take lead responsibility for an implementation plan to replace the 2004 Action Plan for Hepatitis C and ensure a coordinated and effective approach to testing, treating and curing people with the condition and the prevention of new infections

A Hepatitis C Elimination Group, reporting formally to Ministers, to be established to co-ordinate the work of the relevant health organisations in improving services, comprising the relevant statutory and non-statutory organisations and patient, clinical and local government representatives

Testing for hepatitis C and other blood-borne viruses to be provided in a range of healthcare settings to maximise coverage, working to nationally-agreed performance standards as part of structured care pathways

Commissioners to ensure that, as a core part of contracts, service providers collect and report data on their hepatitis C outcomes to standards set by Public Health England

NHS England’s specialised commissioners to ensure the availability of services and NICE-approved treatments for all patients diagnosed with hepatitis C in line with international guidelines

Industry to ensure that new therapies are priced to meet NICE criteria for cost-effectiveness for the whole hepatitis C patient population

Commissioners to work proactively with voluntary sector groups providing advice and support to patients with hepatitis C and to develop prevention strategies targeted at people at risk of contracting the virus

A vision for hepatitis C: Test, treat, cure

The fourth official World Hepatitis Day took place on the 28th July 2014, co-ordinated by the World Hepatitis Alliance and the World Health Organization, and along the theme 

This World Hepatitis Day saw the largest global response to date, with 157 countries taking part. 86 national governments also took part, which is a significant increase from previous years.
The following percentages of WHO member states in each region took part:

World Hepatitis Day 2014 was marked by testing events, fundraisers, pledges, vaccination drives, and other innovative events such as a celebrity car wash, balloon releases and the illumination of well-known landmarks. Support from Ministers of Health, local and regional governments, celebrities, civil society and members of the public was enhanced by high levels of media coverage, meaning this World Hepatitis Day undoubtedly reached a larger and broader audience than ever before.

With this report we would like to acknowledge everybody who helped to make World Hepatitis Day 2014 a huge success.

World hepatitis day 2014 summary report

While the United States of America (USA) has become infamous for having the largest prison population in the world as a result of its regressive drug policy, the impacts of its drug policy towards young people who use drugs are rarely discussed. This case study offers an overview of some of the main drug policy issues facing young people in the USA, looking at the impacts of the drug policy and harm reduction on young people, drawing data and evidence from official national statistics and experiences of young people who use drugs themselves. This paper then concludes with a series of recommendations for potential reform areas.

IDPC/Youth RISE case study series: Drug policy, harm reduction and young people in the United States

This report describes the findings of the Coalition Government’s international comparators study of approaches to drugs misuse and drug addiction. The UK Government has considered a range of policy and operational responses to drugs in other countries and reviewed the evidence of their impacts, where possible drawing out contrasts and similarities with the UK Government’s own Drug Strategy.

During 2013 and 2014, ministers and officials from the Home Office took part in fact-finding visits to, and discussions with, eleven countries: Canada, the Czech Republic, Denmark, Japan, New Zealand, Portugal, South Korea, Sweden, Switzerland, the United States of America and Uruguay. UK Home Office officials also undertook desk-based research on policies in a number of other countries including the Netherlands.

Based on what the authors saw during their fact-finding, and grounded in an understanding of the drugs situation in the UK, they identified a set of themes to focus on – responses to drugs which stood out as particularly innovative, widely discussed, or relevant to the UK situation. They then undertook further research and analysis of the evidence base around each of these themes.

The report concludes that there is no evidence that tough enforcement of the drug laws on personal possession leads to lower levels of drug use.

Drugs: International comparators 

Tens of thousands of patients with terminal illnesses in Mexico suffer unnecessarily from severe pain and other symptoms because they cannot access adequate end-of-life care, Human Rights Watch said in a report released today.

The 122-page report, “Care When There Is No Cure: Ensuring the Right to Palliative Care in Mexico,” documents the lack of access for many patients to pain relief and other assistance known as palliative care. Although Mexico’s health law explicitly grants people with terminal illness a right to palliative care, the service is offered almost exclusively at large specialist hospitals.

Almost 600,000 people die every year in Mexico. Estimates by the World Health Organization and the Worldwide Hospice and Palliative Care Alliance suggest that more than half of these people require palliative care.

Care when there is no cure - Ensuring the right to palliative care in Mexico

for policy-makers offers concise information which is extracted from the 

WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses 

These new WHO guidelines outline basic principles, clinical recommendations and health system recommendations. This brochure highlights selected issues which are essential for, in particular, policy-makers, medicines regulatory authorities, hospital managers and health insurance managers. It will allow them to include in their policies the guidelines’ principle that all patients with pain, including children, should be treated with either pharmacological or non-pharmacological techniques, irrespective of whether the underlying cause can be identified.

address the pharmacological treatment of persisting pain, including cancer pain. As such, it replaces the previous guidelines, 

Cancer pain and palliative care in children

, which exclusively covered cancer pain. The new guidelines on 

are the first of a series of three guidelines documents on all types of pain in both adults and children. The topics of the other two guidelines will be “persisting pain in adults” and “acute pain”.

The World Health Organization (WHO) estimates that around 5.7 billion people live in countries where moderate and severe pain is not adequately treated. Data from the International Narcotics Control Board (INCB) for 2009 show that more than 90 percent of the global consumption of strong opioids occurred in Australia, Canada, New Zealand, the United States of America, the United Kingdom and several other European countries. This means that their availability was very limited in many countries and regions. Over 80% of the world population will have insufficient analgesia.

Medicines for opioid analgesia, such as morphine, are subject to the Single Convention on Narcotic Drugs, 1961, and its 1972 Protocol. As a result, the focus has historically been on prevention of misuse, dependence and diversion while medical access has been neglected. In recent years, growing recognition of the legitimate use of these substances for medical and scientific purposes.

Persisting pain in children package: WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses

 - Injection drug use is the primary mode of transmission for hepatitis C virus (HCV) infection. Prior studies suggest opioid agonist therapy may reduce the incidence of HCV infection among injection drug users; however, little is known about the effects of this therapy in younger users.

 - To evaluate whether opioid agonist therapy was associated with a lower incidence of HCV infection in a cohort of young adult injection drug users.

 In this cohort of young adult injection drug users, recent maintenance opioid agonist therapy was associated with a lower incidence of HCV infection. Maintenance treatment with methadone or buprenorphine for opioid use disorders may be an important strategy to prevent the spread of HCV infection among young injection drug users.

Click here to read the full article (restricted access).

Association of opioid agonist therapy with lower incidence of hepatitis C infection in injection drug users

From 2007 to 2009, the number of opioid drug deaths identified on the National Coronial Information System (NCIS) increased by 25.0% (744 deaths in 2007 compared to 934 in 2009), with an apparent subsequent decrease in opioid related fatalities in 2010 and 2011.

The identified opioid drug deaths had the following characteristics:

The majority of deaths were deemed unintentional (71.2%), while almost one-sixth were due to an act of intentional self-harm (15.8%).

Over two-thirds of deaths involved males (67.1%), with the highest proportion aged between 35-44 years (28.4%).

A slightly higher proportion of females compared with males were involved in deaths involving codeine-containing products.

Heroin was the opioid drug most frequently involved in death (particularly in cases of sole drug involvement), with 84.4% of all heroin-related deaths involving males. 87.6% of all heroin related deaths were unintentional in nature.

Methadone and oxycodone were the second and third most frequently identified opioids involved in death.

Almost three quarters of opioid drug deaths occurred in combination with non-opioid drugs (74.5%). Of the drug classes examined, benzodiazepines and alcohol were the non-opioid drug classes most frequently identified.

Codeine-containing products, morphine, oxycodone and tramadol were more likely to be involved in intentional self-harm deaths than heroin or methadone.

Opioid-related deaths in Australia

This issue of Druglink covers the period 1986- 94, ending with the lead-up to the publication of the first proper UK drug strategy 

. It intends to reflect the key developments of the history of drugs during that period in time, offering snapshots of key stories and experiences in the UK.

Publications