Situation and Problems of Opioids Accessibility: Case Study of Thai Food and Drug Administration

Abstract

This was a cross-sectional study that aimed to investigate (1) the situation of accessibility
of six opioids supplied by Thai FDA, i.e. codeine, morphine, pethidine, methadone, oxycodone,
and fentanyl, for 7 years (2012-2018; 2555-2561 BE), (2) problems of these opioids accessibility
for palliative care, and (3) to make suggestions for appropriate opioids management and policy
for healthcare system in Thailand The data were collected from a national database of opioids
sale volume and a questionnaire distribution to targeted healthcare professionals in the clinical
settings where the opioids were distributed to. The results of the opioids accessibility situation
in Thailand during 2012-2018 suggested that the tendency of the six opioids has been modestly
increasing each year. However, their utilization was still much lower than the annual allocated
quota. Basically, the opioids quota was calculated based on the 3-year retrospective amount of
usage plus the tendency of usage and the number of patients yearly. Thus, the quota was the
reasonable number of opioids utilization, reflecting the overall picture whether appropriate
palliative care and opioids management system were in place. The highest percentage of the
opioids used per their allocated quota was in 2018, where only 52.7% could be achieved.
Subsequently, a questionnaire was distributed to healthcare personnel in the clinical settings
relevant to opioids dispensing to seek for factors affecting opioids accessibility in the healthcare
settings. The survey results demonstrated that codeine and morphine were the top two opioids
วารสารอาหารและยา ฉบับเดือนพฤษภาคม-สิงหาคม 2563 15
those were distributed to approximately 90% of public hospitals. Among the healthcare sectors
where have been using opioids, the palliative care unit was the highest demand group of 55.6%
deemed usage, while 38.0%, 32.8% and 10.5% were the number for anesthetic units, pain clinic,
and drug treatment unit respectively. From the questionnaire re spondents points of view,
the opioids accessibility issues were found in oral morphine, morphine injection, and pethidine
injection. Besides, fentanyl injection, fentanyl transdermal, therapeutic system (TTS), and codeine
could be at moderate accessible group of opioids, while methadone and oxycodone were a low
accessible group. In addition, the top five major problems hampering opioids accessibility included
(1) not accepting exchanges or returning expired drugs, (2) restriction in exchanging opioids among
hospitals in case of nearly expiring or unabling to use before expiry date, (3) not permission in
opioids borrowing system among the hospitals in case of emergency scarcity, (4) reducing sale
volume approval in case of temporary shortage, and (5) complicated rules and regulations for
the hospitals in expired opioids destruction. The respondent healthcare professionals suggestion
for opioids management is to increase awareness of opioid utilization and add the relevant law
curriculum in medical school, revise the rules and regulation of opioids exchanging among
the hospitals, train medical staffs, distribute nation-wide media to attain positive attitude and
understanding about appropriate opioid usage to public, and establish a national information
center to support the opioids stock alert and notify nearly expired amount. Finally, this study
suggests that Thai FDA should revise rules and regulations in relation to opioid management,
improve service by providing advance technology and reduce complicated procedures, create
the opioids node system and pharmacist network in each province, and establish an information
center in Thai FDA where not only to be the opioids coordinating hub but also at raining provider
for healthcare professionals.