Costa Rica Marks Improvement in Morphine Consumption

Abstract

To the Editor: Costa Rica is a small country (51,100 m2) in Central America, with only 3,810,179 inhabitants in 2000.1Instituto Nacional de Estadı́stica y Censo Estadı́stica vital Población.nacimientos, defunciones, matrimonios. 2000; 62: 31-38,49Google Scholar Although Costa Rica is a developing country, its main causes of death are similar to those in well-developed countries. Cancer is the second highest cause of death.2Jaramillo J. Salud y Seguridad Social. Ed 1. Editorial de la Universidad de Costa Rica, San José1993Google Scholar, 3Ministerio de Salud. Incidencia y mortalidad por tumores malignos. San José: Ministerio de Salud, 1996.Google Scholar Programs to improve cancer pain control and palliative care started 11 years ago, but were limited to urban areas. In 1999, Costa Rican Social Security named a National Pain Control and Palliative Care Center (NPCPCC) to encourage and develop a program in pain control and palliative care that could be implemented all over the country. It included guidelines and a basic list of analgesics that were to be used at the I, II, and III levels of medical care.4The Costa Rican National Policy on Pain Control and Palliative Care (Decreto No. 29561-S. Manual de normas de atencion del dolor y cuidados paliativos del I y II nivel. 14/6/2001). Available at http://imprenal.go.cr/gaceta/HTML/Fechas/Decretos/14_6_01.htm.Google Scholar A network of 14 small clinics was created to work all over the country in implementing this program. The World Health Organization (WHO) considers a country's morphine consumption to be an important indicator of improvement in cancer pain relief and an indirect means of evaluating whether palliative care services are available.5Organización Mundial de la Salud Alivio del dolor en el cáncer. OMS, Segunda edición. Ginebra1996Google Scholar It is reported to the International Control Board by member countries, which gives a wide source of data to analyze the situation. Over the last ten years, morphine consumption has increased mainly in 10 developed countries. These countries account for 75% of all morphine consumption; other countries of the world use only 25%. Latin America and the Caribbean use less than 1% of that 25%.6Pan-American Health Organization (PAHO) Palliative Care.Non-Communicable Diseases: framework for a regional project on cancer palliative care in Latin America and the Caribbean. 2000; 8: 1-8Google Scholar, 7Joranson D.E. Smokowski P.R. Tendencias en el consumo de opioides en Suramérica. Madison, WI: PPSG, Pain and Policy Studies Group. University of Wisconsin, WHO Collaborating Center1996Google Scholar According to the reports given by WHO, Costa Rica's morphine consumption in 1984 was far below 1 mg per capita.6Pan-American Health Organization (PAHO) Palliative Care.Non-Communicable Diseases: framework for a regional project on cancer palliative care in Latin America and the Caribbean. 2000; 8: 1-8Google Scholar, 7Joranson D.E. Smokowski P.R. Tendencias en el consumo de opioides en Suramérica. Madison, WI: PPSG, Pain and Policy Studies Group. University of Wisconsin, WHO Collaborating Center1996Google Scholar Therefore, it is important to analyze morphine consumption in Costa Rica to determine its behavior in a 7-year period from 1993–2000 to indirectly measure improvement in cancer pain management. This analysis of morphine consumption in private and public health centers shows an increase from 1.011 mg per capita in 1993 to 2.915 mg per capita in 2000 (Figure 1). This increment from 1993 to 2000 is a 188% increase. There was only a slight decrement from 1999 to 2000. Morphine consumption has increased in Costa Rica due to changes in polices and health law regarding pain control and palliative care. For instance, the maximum days of morphine prescription has changed from 2 to 8 days, the maximum amount of morphine patients can be prescribed has also changed to the amount required by the patient.8Ministerio de Salud. Reglamento Nacional para el Control de Drogas y Estupefacientes No.25571-S. 1/10/96.Google Scholar The government now pays up to 6 months to the caregiver of a terminally ill patient, regardless of whether the job is in the private or public sector.9Law No. 7756, “Instructivo Beneficio para los Responsables de Pacientes en Fase Terminal,” March 20, 1998.Google Scholar A basic list of analgesic medications has been introduced all over the country for the I, II, and III levels of medical care. Patients' and families' attitudes have been changing toward pain control and palliative care because they are now better informed through the health professionals who work at the pain and palliative care network. Newspapers, television, and radio also have been playing an important role in this matter. Public medical schools have started to include pain control and palliative care in their study programs, but the private medical schools have not yet included it. We would like to thank the Costa Rican National Narcotics Bureau, the Instituto Nacional de Estadı́stica Censo (INEC), and the Centro Nacional de Informacı́on de Medicamentos (CIMED) for providing the statistical data for this letter.