Mexico: Breakthrough for Pain Treatment

Mexico's introduction on June 15, 2015, of a new system for prescribing and dispensing strong prescription pain medicines will significantly improve health care for people with advanced illnesses, Human Rights Watch said today.

"This is very good news for patients and their families," said Diederik Lohman, associate health director at Human Rights Watch. "It will significantly improve access to essential medicines that have been unavailable to tens of thousands of people who have been suffering unnecessarily."

Estimates by the World Health Organization and the Worldwide Hospice and Palliative Care Alliance suggest that more than half of the 600,000 people who die every year in Mexico require palliative care, frequently including treatment of significant pain.

The new system allows physicians to download from a secure website special prescriptions with bar codes required for prescribing opioid pain killers. It also introduces electronic record keeping for pharmacies.

Until now, physicians had to travel in person to state capitals to obtain bar code stickers, a highly time-consuming requirement that discouraged many physicians from prescribing these medicines. Pharmacies had to record all transactions involving these medicines in multiple log books, a significant bureaucratic burden.

Opioid analgesics such as morphine are essential for the treatment of moderate to severe pain due to cancer, among other conditions. Because of the potential for diversion and misuse, international law requires countries to regulate prescription and distribution of these medicines.

A 2014 Human Rights Watch report found that Mexico's regulations were so burdensome that the vast majority of doctors, especially those living outside state capitals, simply did not prescribe these medications and that very few pharmacies had them in stock.

Human Rights Watch detailed the dramatic consequences for patients with cancer and other advanced illnesses, who were often forced to choose between traveling long distances to obtain pain medicines or facing unrelieved agony at home.

Remedios Ramirez, a 73-year-old woman with advanced pancreatic cancer, told Human Rights Watch that she had to travel four hours each way from the state of Hidalgo to Mexico City to get morphine because hospitals closer to home did not have physicians who could prescribe it for her.

In March 2013, after Human Rights Watch, the Mexican Health Foundation, and local palliative care providers had alerted the authorities to the problems with legitimate prescribing of opioid analgesics, the Federal Commission for the Protect Against Sanitary Risks (Comision Federal para la Proteccion Contra Riesgos Sanitarios, COFEPRIS), Mexico's regulatory agency for medicines, announced it would develop the electronic system as part of an effort to improve end-of-life care.

Apart from simplifying prescription of opioid analgesics, the electronic system also improves government oversight of their use.

Human Rights Watch found in 2011 that pharmacies were unable to scan the bar code stickers on prescriptions for opioid analgesics to authenticate them because they were not linked to a central system. Thus, the requirement for bar codes, which was intended to allow close monitoring of prescribing and dispensing opioid analgesics, did not actually help prevent their misuse, while it created a major barrier to legitimate use.

Under the new system, pharmacies will be able to authenticate prescription forms using the bar code, and scripts will be automatically canceled once they have been scanned. The Mexican government should ensure that doctors and pharmacies are properly trained on the new system, Human Rights Watch said.

The new system for prescribing opioid analgesics is one of a series of measures by the Mexican government to improve access to palliative and end-of-life care. Pain treatment is an important component of this kind of health care.

In December 2014, the Health Ministry issued guidelines to its healthcare system to put into effect provisions on end-of-life care outlined in Mexico's 2009 health law and created a department to advance palliative care.

In January 2015, the government adopted an interagency agreement on palliative care, which made it mandatory and instructed medical schools to include it in their curricula.

While Mexico has made significant strides in improving access to palliative care, significant challenges remain. Human Rights Watch found that the availability of palliative care is uneven, and limited, throughout the country. As of October 2014, 7 of Mexico's 32 states did not have a single hospital that offered palliative care and in another 17 states, palliative care services only existed in capital cities.

"This new system removes major administrative barriers that have discouraged the use of medicines to treat severe pain," Lohman said. "But many physicians and pharmacies have never used them so training will be essential."