Opioid Use in the Philippines — 20 years after the introduction of the WHO analgesic ladder

Aim: To find out if the opioid usage has improved in the Philippines 20 years after the introduction of the WHO analgesic ladder. Background: Twenty years after the introduction of the WHO analgesic ladder in the Philippines, usage of morphine for cancer pain relief is still low. Barriers to opioid prescribing persist because of factors attributable to physicians, patients, families and constraints imposed by government regulatory bodies. Methods: A survey of 211 physicians on a purposive sampling representing various regions in the country was done. Respondents included anesthesiologists, surgeons, oncologists, and palliative care specialists, who were expected to prescribe opioids in their practice. A 20‐item multiple‐choice questionnaire was developed to explore possible barriers to opioid prescribing. Results: There is a very good awareness of the WHO analgesic ladder (72%) as well as the availability of opioids in their areas of practice (89.57%). Monitoring of pain as the “fifth vital sign” is adhered to by 68.25% of the respondents. There was only 60.66% compliance regarding availment of a narcotics license among respondent physicians. Various reasons were identified as to why they failed to get a narcotics license. Conclusions: There was adequate knowledge about the WHO analgesic ladder among the respondents. There is a perceived resistance to prescribe strong opioids like morphine making the step 2 of the ladder as a comfort zone by the physicians who tend to “overstay” in this step. Government regulatory policies have affected the physicians' attitudes concerning narcotics license application. There is a very slow, though steady increase in morphine and oxycodone usage in the country. Barriers to opioid use in cancer pain management still persist twenty years after the introduction of the WHO analgesic ladder.