Abu Dhabi // Doctors and patients are calling for the UAE to reconsider its ban on opioids - drugs derived from the poppy that are widely used as painkillers in Europe and North America. "Patients are missing out on one arrow in the quiver that might potentially help them," said Dr Michael Clark, associate professor and director of chronic pain treatment programmes at Johns Hopkins medical institutions.
"It's like saying, 'What if we didn't have penicillin?' You might be able to make do with the antibiotics you have left, but there might be a lot of people who could benefit, more cheaply, more completely with penicillin. The same argument is held for opioids." Pain management improves the quality of life for chronic pain sufferers, experts say, and eases the burden on the healthcare system and society, as patients are more likely to continue normal lives.
The opioid class of drug, which includes codeine, is controversial because of its addictive properties. In many countries it is used liberally by people with terminal illnesses, to reduce their suffering. It is often used for cancer and surgical patients, with the intake closely monitored by their doctors. "In places like the UAE, narcotics are restricted because of the fear of drug abuse," Dr Clark said. "If we get someone without an addictive personality and we give this for a legitimate problem, we think [the risk of their becoming addicted] is pretty low, but it is probably not zero."
Some prescription or over the counter medicines bought in other countries are illegal in the UAE, including codeine, a common pain relief medication which is an alkaloid occuring in opium and poppy seeds. In 2005, Tracy Wilkinson, 27, was arrested at Dubai airport for possessing the drug, which had been prescribed for back pain. She was held in custody for two months before being released after a letter from her doctor in the UK confirmed the codeine was for medical purposes only. Mrs Wilkinson had faced four years in jail if found guilty.
The Ministry of Health, which regulates drugs in the Emirates, was unavailable to comment. The pain clinic at Tawam Hospital in Al Ain is hosting a pain management conference on October 27-28 which will explore these issues. Dr Rasha Jabri, the head of the clinic, said she had seen the effect of giving patients unlimited pain medication when she was training in the United States. "The UAE and the surrounding countries are on the other extreme, which is no opioids at all," Dr Jabri said. "What we need is a balanced way to give the medication to the people who need it with good regulation. The extreme reaction of not having opioids at all is not good for the patient."
Dr Jabri thinks regulation can reduce the risk for abuse, allowing patients to get the benefits of opioids and lower their chances of becoming addicts. She also believes pain management is an essential part of medical care. "I wouldn't say controlling pain is only for quality of life although it is very important to be humane and not let people suffer but it does change your outcome in a medical situation," she said.
Patients who had undergone chest or upper abdomen operations could die from complications of their pain, if they did not receive adequate medication. "A total knee replacement is one of the most painful surgical procedures that a patient can have," Dr Jabri said. "If you don't have adequate pain relief after the surgery, then the surgery will fail. Not because of the surgical technique, but the patient will not be able to do the rehabilitation necessary to increase the range of motion in the knee.
"Severe pain, like surgical pain or cancer pain, is severe enough to warrant having opioids in the regimen." Linda Arthur has suffered chronic back pain since November, when complications from a medical procedure left her walking with a cane and dependent on painkillers. "I am on all kinds of pain medicines, but I don't take near the amount they prescribe because then I can't function," said Ms Arthur, a 47-year-old English tutor from Al Ain.
"It is hard on the family and myself. In dealing with the pain I might be OK for a little bit, when I can get up and do things, but after walking around for a little bit I can't do it any more. I have to come home and rest." She thinks the Government should consider adding some opioids to the list of controlled substances that doctors can prescribe. "Be it cancer patients or chronic pain patients, we have to have codeine. It is number one on my list of drugs that we really should have here," Ms Arthur said. "The hospitals' favourite thing to prescribe for pain is Panadol, and I think that's good for a headache, but not after surgery, not for chronic pain."
She said she did not enjoy taking painkillers, but regarded it as a necessity. "I want to live life, and unfortunately I will always be on medication." she said. "I cannot function on the amount they have to give me because other medications are not available here." firstname.lastname@example.org