Availability of Internationally Controlled Essential Medicines in the COVID-19 Pandemic
Availability of Internationally Controlled Essential Medicines in the COVID-19 Pandemic
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DOI：
10.1016/j.jpainsymman.2020.04.153
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发表时间：
2020-08-01
影响因子：
4.7
通讯作者：
Radbruch, Lukas
中科院分区：
文献类型：
--
作者：
Pettus, Katherine;Cleary, James F.;Radbruch, Lukas
《2019年世界卫生组织基本药物标准清单》第2部分包括常用于控制疼痛和呼吸窘迫的阿片类镇痛药制剂，以及镇静和抗焦虑物质，如咪达唑仑和地西泮。这些药物对姑息治疗至关重要，受联合国专门机构和条约机构监督的国际药物管制公约以及国家药物管制法的管制。这些国家法律和法规直接影响到国际管制基本药物（ICEM）的床边供应。国家监管体系与全球供应链之间的复杂互动（目前受到COVID-19大流行的影响）直接影响了ICEM的床边可用性和患者护理。尽管数十年来全球民间社会在联合国系统中进行了宣传，但低收入和中等收入国家仍然长期无法获得、无法获得和负担得起ICEM，最近有报告称高收入国家也出现短缺。COVID-19最常见的症状是呼吸困难、咳嗽、嗜睡、焦虑、激动和谵妄。经常使用的药物包括阿片类药物，如吗啡或芬太尼和咪达唑仑，所有这些药物都被列为ICEM。本文描述了在COVID-19大流行期间，所有收入水平国家的重症监护和姑息治疗患者缺乏ICEM可用性和获得ICEM的机会有限的相关问题，并提出了改善获得ICEM的建议。(C)2020年美国临终关怀和姑息医学学院。爱思唯尔公司出版All rights reserved.
Section 2 of the 2019 World Health Organization Model List of Essential Medicines includes opioid analgesics formulations commonly used for the control of pain and respiratory distress, as well as sedative and anxiolytic substances such as midazolam and diazepam. These medicines, essential to palliative care, are regulated under the international drug control conventions overseen by United Nations specialized agencies and treaty bodies and under national drug control laws. Those national laws and regulations directly affect bedside availability of Internationally Controlled Essential Medicines (ICEMs). The complex interaction between national regulatory systems and global supply chains (now impacted by COVID-19 pandemic) directly affects bedside availability of ICEMs and patient care. Despite decades of global civil society advocacy in the United Nations system, ICEMs have remained chronically unavailable, inaccessible, and unaffordable in low- and-middle-income countries, and there are recent reports of shortages in high-income countries as well. The most prevalent symptoms in COVID-19 are breathlessness, cough, drowsiness, anxiety, agitation, and delirium. Frequently used medicines include opioids such as morphine or fentanyl and midazolam, all of them listed as ICEMs. This paper describes the issues related to the lack of availability and limited access to ICEMs during the COVID-19 pandemic in both intensive and palliative care patients in countries of all income levels and makes recommendations for improving access. (C) 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.