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Country Profile

The Project

  • Introduction
  • Why this project?
  • Aims & goals
  • How it works
  • Strategic impact
image representing the phrase: 10 partners, 5 years, 1 vision

The ATOME project aims to improve access to opioids across Europe. A consortium of academic institutions and public health organizations is working to help governments, particularly in Eastern Europe, identify and remove barriers that prevent people from accessing medicines that could improve end of life care, alleviate debilitating pain and treat heroin dependence.

About 1.7 million people in Europe die from cancer each year, many experiencing severe pain, even though effective pain medications exist. Launched in December 2009 in Aachen, Germany, and co-led by the University of Aachen, Lancaster University (UK), and the World Health Organization (WHO), the Access to Opioid Medication in Europe (ATOME) project will address the legal, administrative and organisational barriers that impede access to pain management for treatment of cancer and other conditions in many European countries.

We have made great progress in pain management in the last decade, and nobody ought to suffer from pain, but still patients are dying in terrible pain, without a chance to get morphine. Our new project aims to work closely with policy makers and doctors in 12 countries to remove legal barriers to access to morphine and other opioids.
Professor Lukas Radbruch, Chair of Palliative Medicine of the University Hospital Bonn / President of the European Association for Palliative Care

There is great variability across European countries in terms of legal controls of morphine and other opioids. This means that in some countries it is very difficult for doctors to prescribe pain management medicines. In other cases, physicians may be unfamiliar with prescribing this special class of medicine. As well, misperceptions around opioids and dependence can limit access for both pain management and treatment of drug dependence.

The overall goal of this project is to undertake applied research into the reasons why opioid medicines for moderate to severe pain and for the treatment of opioid dependence are not used adequately in 12 European countries, and to elaborate and disseminate tailor-made recommendations to each country for improving the accessibility, availability and affordability of controlled medicines, and disseminate these to governments, health-care professionals, other key decision-making bodies as well as to the general public.

The overall goal will be implemented through three specific objectives.

Specific objective 1:
To undertake a national situational analysis in 12 European countries with regard to access to controlled medicines, including their availability, rational use, and causes for underuse; and to make recommendations to their national governments for improvements. This specific objective will be implemented through work packages 1-6.
Specific objective 2:
To undertake an external review of relevant national legislation in 12 European countries and recommend, in compliance with the international drug conventions, appropriate amendments to governments in order to improve access for legitimate and rational use of controlled medicines. This specific objective will be implemented through work packages 6-9.
Specific objective 3:
To elaborate and introduce a research and monitoring tool for tracking and comparing the extent of opioid availability in the 12 target countries. This specific objective will be implemented through work package 10.

With a commitment of 2.45 million Euro over five years from the European Commission's 7th Framework Programme, the ten ATOME partners will work with the country teams, including government officials and public health and medicines experts, to carry out legislative and policy reviews, leading to recommendations that will facilitate access for all patients requiring treatment with medicines controlled under the international drug conventions.

This is in line with our ongoing work to improve access to these medicines worldwide. The potential benefits of this partnership extend well beyond palliative care. For example, there are around 3.7 million people who inject drugs in Europe, but only a minority has access to methadone therapy. Such therapy not only helps them manage their dependency, but also helps their social re-integration and prevents them using 'street drugs' which increase their risk of harm and lead to infections like HIV from needle sharing.
Willem Scholten, of the WHO Access to Controlled Medicines Programme
This is a very exciting project that will make a real difference to patients with cancer and their families and will help them to cope with the disease, enabling them to live their life without pain until the very end.
Professor Sheila Payne, Director of the International Observatory on End of Life Care at Lancaster University

The work in the ATOME Project follows two tracks in parallel.

One track is related to the analysis of national policies and national circumstances that affect the accessibility and availability of the medicines involved. The goals are both to make recommendations to the government and to make professionals aware of problems arising from their professional practice, by undertaking a national situational analysis with regard to controlled medicines, including their availability, rational use and causes for underuse. Furthermore, in this track a plan will be drafted on how the implementation of these recommendations can be promoted at country level.

The other track looks at optimising the relevant legislation in order to acknowledge both the prevention of abuse and dependence and the medical need for these medicines. The goal is to make recommendations on how to optimize the legislation for equal or even better prevention of abuse and dependence and making the medicines concerned readily available and accessible for rational medical use at the same time.

These tracks are realised through 11 work packages:

ATOME structure of activities

Flowchart demonstrating the ATOME structure of activities

This project will have impacts in the following six spheres:

Development of tools and standards:
The publication of the WHO guidelines Ensuring Balance in National Policies on Controlled Substances, guidance for accessibility and availability of controlled medicines in 10 languages, will provide an up-to-date and internationally agreed standard for policy and decision makers in Europe and other countries. This publication is an update of the older guidelines Achieving Balance in National Opioids Control Policy. The development and introduction of the International Opioid Consumption Database will allow national governments, international organisations and the general public to access country specific opioid consumption data, which will promote transparency, benchmarking, measuring, monitoring of and comparison between countries on the current status and future improvements in opioid availability in Europe.
National policy-making processes and access to pain medication and substitution treatment:
The outcome of the research undertaken in 12 European countries will result in country reports including concrete recommendations for legislative changes. These reports will be presented to relevant ministries, national organisations and health-care professionals in the 12 countries. This is expected to lead to the adoption of policies allowing for improved access to pain medication and national action in the area of substitution therapy. Better treatment of opioid dependence would contribute to decreased mortality rates, most importantly due to decreased HIV and hepatitis C infections, as well as addressing issues related to the prevention of opioid abuse.
National capacity building:
The six-countries workshops, national follow-up conferences in 12 countries and the review training for national and external lawyers will directly and indirectly build national capacities among civil servants and national lawyers in the area of policies for pain management, palliative care and opioid dependence. In total, 12 civil servants and three attorneys or lawyers will be trained in recognising barriers to opioid access and in analysing controlled drug legislations. Through national symposia and media communications, many more will be informed about the rational use of opioid analgesics and of treatment of heroin dependence with long-acting opioids.
Research collaboration and sharing of experiences in Europe:
This project will stimulate close collaboration, both among the wide range of health-related professionals in the Country Teams, and among the six Country Teams participating in each of the two workshops. The multi-country workshops will ensure that the applied research (situational analysis, policy and legislative reviews and recommendations) and country specific experiences are shared among participating countries. This project represents a first initiative to undertake research into opioid availability at European level and it is likely to stimulate the creation of a network that will last beyond the duration of the project.
Contribution towards the implementation of European policies:
The ATOME project has an impact on the implementation of policies. It is elaborated as part of the overall framework of the WHO Access to Controlled Medication Programme. Moreover, it supports the implementation of the goals of the Council of Europe which has established that palliative care is an inalienable element of a citizen's right to health care and that it is therefore a responsibility of the governments to guarantee that palliative care – including adequate pain treatment - is available to all who need it. The Council of Europe also states that the differences in the availability and quality of palliative care throughout Europe need to be addressed through increased co-operation between countries.
Impact on the patients and populations themselves:
The project is expected to have a positive impact for people in need of pain medication, people with opioid dependence and, related to the latter, populations at risk for attracting HIV and HCV infections. For a wide variety of conditions, patients do not achieve pain relief (analgesia in medical terms) without the use of controlled medicines: for example in cancer pain, HIV neuropathy, diabetic neuropathy, chronic pain, surgery pain (both around and after surgery), traumatic pain and sickle-cell disease. Opioid dependence increases mortality rates due to the poor quality and uncertain strength of heroin on the illicit markets and countries with a high prevalence of untreated illicit opioid use relate to high transmission rates of blood-borne diseases like HIV and HCV, even for the non-opioid dependent part of the population. The ATOME project promotes equal access to opioid medication to millions of patients affected by the above medical conditions in 12 European countries.