European Association for Palliative Care
EAPC
The European Association for Palliative Care (EAPC) is a membership organisation committed to supporting the promotion and development of palliative care throughout Europe and beyond.
ID: 006087021537-90
Lobbying Activity
Meeting with Aurelijus Veryga (Member of the European Parliament)
27 Jan 2026 · Advancing Palliative Care Policy and Access Across Europe
Response to Pharmaceutical Strategy - Timely patient access to affordable medicines
7 Jul 2020
The European Association for Palliative Care welcomes the roadmap for a pharmaceutical strategy for Europe and wishes to comment specifically on the availability and accessibility of controlled medication.
Issues
Although opioids and other analgesics are widely manufactured, the availability is very variable across Europe. Evidence of these disparities can be seen in many measures, for example The Adequacy of Consumption Index (ACM) which allows the comparison of opioid consumption across Europe. In the ACM, the baseline of 100% was calculated from the average opioid consumption of the top 20 countries in Europe in 2013. The ACM demonstrates huge variation where the average consumption in the top three European counties was 127% (in Denmark it was 189%), compared to very low levels in Cyprus 4%, Estonia 6%, Lithuania 12% (Vraken 2018). Other studies have also demonstrated opioid underuse in long term care facilities. Using data on opioid prescriptions for the last week of life of deceased residents, researchers estimated that level of opioid use as 19% for patients in the Netherlands but 79% in Poland (Tanghe 2020).
Barriers
There would appear to be many barriers explaining this underuse and lack of accessibility to pain and symptom relief, and the European Union funded Access to Opioid Medication in Europe (ATOME) project looked at the issues in 13 European countries. This found issues in the regulation of opioids within countries, legislative barriers to their availability, limited knowledge, education and training of healthcare professionals and a lack of public awareness of the effectiveness of pain management (Linge-Dahl 2015). Moreover, there was evidence that there is a lack of financial resources and often inadequate knowledge and awareness of the issues of opioid access and prescribing by policy makers (Vranken 2020)
Thus, there is a need for increasing awareness of the public, governments and health care professionals in access to and utilisation of this medication, to reduce pain and distress. There is also a need for clear national policies and guidelines. There is a continuing fear of the misuse of opioids, but this may reflect the need for increased education and understanding by all involved to ensure that medication is readily available for medical, legitimate use for patients who require opioids whilst ensuring minimum risk of opioid diversion (Knaul 2018).
European Union
The European Union has been supportive of the United Nations General Assembly Special Session on Drugs in 2016, and its commitment to improve access to controlled drugs for medical and scientific purposes. The European Union Drugs Strategy also supports this aim and the EU put a resolution to the Commission on Narcotic Drugs (CND)(E/CN.7/2020/L.4) at the CND meeting in March 2020 to promote the awareness -raising, education and training to ensure access to availability of controlled substances for medical and scientific purposes.
COVID19
During the COVID 19 pandemic, opioids have been an essential part of the treatment of patients for the palliation of severe symptoms and for those dying of the virus. The availability and accessibility to opioids is essential within all areas of care, including long term care facilities, to ensure that people living with and dying from the virus are able to receive adequate palliative care and die without distress. The pandemic has highlighted the need for both palliative care and opioids to provide care at the end of life.
Conclusion
Thus, the EAPC would support addressing the needs for the availability and accessibility to opioid medication for the relief of pain and distress. All European citizens should be entitled to the relief of pain and distress and to be able to die without distress.
References:
Knaul. The Lancet 2018; 391: 1391- 1454.
Linge-Dahl L J Pall Med 2015; 18: 1033- 1039.
Tanghe M Pall Med 2020; 34: 784-794.
Vranken J Pall Med 2018; 21: 963-969. Pall Med 2020; 34: 493-503
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