Disparities and crisis: access to opioid medicines in Mexico

The Lancet Commission on Palliative Care and Pain Relief report1Knaul FM Farmer PE Krakauer EL et al.Alleviating the access abyss in palliative care pain relief–an imperative of universal health coverage: report.Lancet. 2018; 391: 1391-1454Summary Full Text PDF PubMed Scopus (442) Google Scholar identified an extensive, global gap between need that has been ignored overlooked quest for coverage. Our found that, while high-income countries tend to stock much more opioid medication than needed, most low-income middle-income (LMICs) have only a small proportion required relieve serious health-related suffering (SHS).1Knaul Only 1% medicines—measured distributed morphine equivalent—are which poorest 50% population reside. By contrast, 90% these medicines are kept wealthiest 10% countries. Mexico, upper-middle-income country is widely recognised as pioneer coverage, served anchor analysis because availability robust data depth breadth policy initiatives.1Knaul Scholar, 2The EconomistUniversal care, worldwide, within reach.https://www.economist.com/leaders/2018/04/26/universal-health-care-worldwide-is-within-reachDate: Apr 26, 2018Date accessed: December 19, 2020Google 3Knaul Gonzàlez-Pier E Gómez-Dantés O al.The achieving social protection all Mexico.Lancet. 2012; 380: 1259-1279Summary (320) Although Mexico far better position many other measured equivalent using from International Narcotics Control Board, stocked third opioids needed less 5% meet overall 2010 2013.1Knaul In Public Health, David Goodman-Meza coauthors4Goodman-Meza D Friedman J Kalmin MM al.Geographical socioeconomic disparities 2015–19.Lancet Health. 2020; 6: e88-e96Summary (7) provide update 2019, novel prescription surveillance Federal Protection against Sanitary Risk (COFEPRIS). authors demonstrated medications increases significantly with status state (rate ratio [RR] 1·88, 95% CI 1·33–2·58, p=0·00016)—when comparing states very high those low status, they observed ten-times higher level (RR 10·45, 2·56–44·15). innovative by colleagues demonstrates across compounded gross inequities them. Such analyses should be replicated wherever available. Linking change important relief too often when assessing declared coverage 2012, based largely effective extension through national health-care programme, Seguro Popular.3Knaul However, unattainable without addressing one basic essential elements care—the suffering—and evidence indicates this element sorely lacking similar LMICs. rapidly became obvious due work interinstitutional group, included representation executive judicial branches Mexican Government, civil society academia, Human Rights Watch,5Lohman García AH there no cure. Watch, New York, NYOct 28, 2014https://www.hrw.org/report/2014/10/28/care-when-there-no-cure/ensuring-right-palliative-care-mexicoDate launch Commission.1Knaul response, considerable progress was made legislative, policy, programmatic fronts 2014 2019.1Knaul 4Goodman-Meza For example, Ministry Health issued detailed technical regulations make existing laws operational 2014,6Diario Oficial de la FederaciónNORMA Mexicana NOM-011-SSA3-2014, Criterios para atención enfermos en situación terminal través cuidados paliativos.https://www.dof.gob.mx/nota_detalle.php?codigo=5375019&fecha=09/12/2014Date: Dec 9, 2014Date 7, subsequently devoted increased administrative resources, promoted physician training, collection. 2015, COFEPRIS changed allowing complex, paper prescribing controlled medicines, electronic prescribing. As 2016, Popular provided public insurance 50 million Mexicans focused populations, explicitly package at primary secondary levels care.7Comisión Nacional Protección Social SaludSeguro PopularSecretaria SaludCatálogo Universal Servicios Salud, Causes 2018. Comisión City2018http://www.documentos.seguro-popular.gob.mx/dgss/CAUSES_2018c.pdfDate January 13, 2021Google basis COFEPRIS, colleagues4Goodman-Meza showed extensive efforts did not translate into significant increase medication. dispensing steadily 2015 unequally country, likely extreme care. 2020 landmark year several reasons—none them positive. programme dismantled January, 2020, leaving Mexicans, especially poor unsalaried workers who lack security, publicly funded insurance.8Frenk Knaul Arreola-Ornelas H Salud: Focos Rojos: Retroceso los tiempos pandemia. Debate, City, Mexico2020Google 9Reich MR Restructuring reform, style.Health Systems Reform. (published online Jun 22.)https://doi.org/10.1080/23288604.2020.1763114Crossref (26) Furthermore, closure done establishing replacement—the Instituto Salud el Bienestar (INSABI)—leaving system precarious state.8Frenk absence clarity regarding operation INSABI continues, extension, little known about how will or financially covered future. addition demise disruption supply created, conditions worsened considerably March, COVID-19 pandemic began. caused sudden SHS resulting demand medicine dyspnoea thoracic (Allende S, National Cancer Institute [Mexico Mexico], personal communication).10Radbruch L Lima LD Joncheere CD Bhadelia A key role response tsunami suffering.Lancet. 395: 9-15Summary (134) experience unit illustrates result fixed limited various decreased patients cancer communication). These decreases coincided challenges local production major suppliers sanctioned. All factors contributed scarcity resulted excess their families where syndemic continues unabated.11University Miami Observatory Containment Americas. Mexico. Policy Adoption Index.http://observcovid.miami.edu/mexico/Date 12Institute Metrics EvaluationCOVID-19 projections: Mexico.https://covid19.healthdata.org/mexico?view=total-deaths&tab=trendDate While resources tackle could foreseen, if government actors had changes put forward Commission1Knaul prepared facilitate guaranteed Going forward, priority makers alleviate immediate future SHS. Monitoring ensure suffering, among neither nor neglected. I report fees Merck KGaA; grants Roche, Vitas Healthcare, Chinoin; travel expenses Grunenthal Foundation; organisations whom collaborate MSD, Pfizer, Novartis, Grunenthal, outside submitted work. also Chair Relief. would like thank Héctor Arreola-Ornelas, Silvia Allende, Sonia Xochitl Ortega Alanis providing background ideas were incorporated paper, Renu Sara Nargund excellent research assistance, Stephanie Sutherland support developing outline. Geographical 2015–19: retrospective dataMeasures introduced federal Government needs marginally successful raising rates. Opioid improved live geographical areas lower status. Full-Text Open Access