Abstract
In Thailand, nowadays, there is an increasing number of terminally ill patients who need palliative care. Opioids are deemed to be an essential treatment for severe pain that can help to reduce suffering and increase the quality of life significantly. Even though opioids have been already included in the National List of Essential Medicines in Thailand, access to this kind of treatment remains a problem. This study aims to explore the factors that influence the access to opioids for palliative care in Thailand. The methodology used in this study includes literature and document review, in-depth interview, as well as focus group discussion which obtained data from personnel in the national institutes related to opioids regulation and palliative care. Key informants consisted of patients’ representatives, doctors, nurses, and pharmacists. Data collection was performed in nine secondary- and four tertiary-hospitals. Thereafter, record files were transcribed verbatim in accordance with key informants’ consent and analyzed as content analysis. This study found that obstacle factors to access opioids for palliative care are divided into four issues including (1) opioids regulations are inconsistent with practices when opioids are suddenly out of stock or nearly expired; however, hospitals cannot borrow or swap these drugs from each other. (2) Inadequate drug management system leads to insufficient amount of drugs stored in hospitals as recommended by the WHO. (3) Doctors, nurses, and pharmacists acquire scarce knowledge of and have negative perspectives toward opioids that cause them afraid to prescribe opioids. Besides that, patients and relatives and laypeople are lack knowledge and understanding of opioids which results in unacceptance. (4) Governance and palliative care system are not robust together with vague policy, deficient budget for operation, unreadiness of services, lack of monitoring and evaluation. This study recommended (1) revising regulations for consistency with opioids administration and management. (2) developing a management system for medical supplies in areas. (3) improving the education system and training for professions as well as counselling or advising patients and their relatives and within the community. (4) Promoting governance for accessing opioids.
