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Sir,
1999-2000 I was involved in the medical care in Kosovo, working with MSF.
The availability of peripheral analgesics and opioids was on an acceptable
level both due to the rest supplies of the Yugoslav health system (where
not looted) and donations of the NGOs. The local medical staff usually
used opioids reasonably, although a bit more restrictive then in Europe.
While the supply for acute care, e.g. emrgencies and short term clinical
treatment rearly was a problem, difficulties arose for supplying chronic
patients, espercially those, living in remote areas. I can recall cases of
withdrawal because somebody (usually mobile unit)put the chronic pain
patients on opioids and let the further supply to be organised by
themselves. The same is applicable for all CNS-active drugs, especially
antidepressants and anxiolytics which are widely used in the conflict
areas.
Concerning the reasons of low opioid availability it is important to
differentiate between the restrictive state policy and insufficient or no
supply due to economical reasons, especially grave in the conflict areas.
In the last case the involved organisations should seek the ways to ensure
continuous supply from the very beginning. Here it may be helpfull to
establish a dialogue between the NGOs, the local medical workers and the
authorities at an early stage.
To ensure continuous care
Sir,
1999-2000 I was involved in the medical care in Kosovo, working with MSF.
The availability of peripheral analgesics and opioids was on an acceptable
level both due to the rest supplies of the Yugoslav health system (where
not looted) and donations of the NGOs. The local medical staff usually
used opioids reasonably, although a bit more restrictive then in Europe.
While the supply for acute care, e.g. emrgencies and short term clinical
treatment rearly was a problem, difficulties arose for supplying chronic
patients, espercially those, living in remote areas. I can recall cases of
withdrawal because somebody (usually mobile unit)put the chronic pain
patients on opioids and let the further supply to be organised by
themselves. The same is applicable for all CNS-active drugs, especially
antidepressants and anxiolytics which are widely used in the conflict
areas.
Concerning the reasons of low opioid availability it is important to
differentiate between the restrictive state policy and insufficient or no
supply due to economical reasons, especially grave in the conflict areas.
In the last case the involved organisations should seek the ways to ensure
continuous supply from the very beginning. Here it may be helpfull to
establish a dialogue between the NGOs, the local medical workers and the
authorities at an early stage.
Kind regards
Dr. Andrej Andrejew
Competing interests:
None declared
Competing interests: No competing interests