1 / 38

Nepal Case Study

Nepal Case Study. International Pain Policy Fellowship Training Program Madison, Wisconsin, USA 6 August 2012 Bishnu D. Paudel , MD Nepal. Nepal. The Lord Buddha born in 623 B.C. Nepal. 2/3 rd Cancer are in advanced stage

elga
Download Presentation

Nepal Case Study

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Nepal Case Study International Pain Policy Fellowship Training Program Madison, Wisconsin, USA 6 August 2012 Bishnu D. Paudel, MD Nepal

  2. Nepal

  3. The Lord Buddha born in 623 B.C

  4. Nepal • 2/3rd Cancer are in advanced stage • Pain was most common symptom in these advanced cancer patients.

  5. Penis Cancer Cancer in advanced stage

  6. 2008 in Nepal Pain was not treated optimally due to multiple reasons. Unavailability of opioids was most important cause. No morphine syrup Morphine Tablet supply was irregular

  7. International Pain Policy Fellowship 2008 • Ministry of Health Representative • International Pain Policy Fellow

  8. 1) Policy 2) Drug Distribution System 3) Cost of Opioid Analgesics 4) Knowledge & Attitudes Barriers of opioid availability

  9. Drug Distribution System • Collaboration with different people including importers to improve opiod availability by timely reporting and proper action

  10. Dear Dr. Paudel, • 1) Order and the permission to import Morphine tablets granted to the overseas buyer by the Drug Control authority of the country is send to the concerned Manufacturing unit. • 2) Based on the ordered quantity, the requirement of active drug Morphine Sulphate is worked out and a separate application for allotment of quota of Narcotic Drug (Morphine Sulphate) is made to the State Drug Control authority. (period 45 to 60 days subject to availability of material) • 3) The necessary allotment is given after scrutiny of the application for obtaining Morphine sulphate from the manufacturer namely Govt. Opium Alkaloids Works (Neemuch/Ghazipur). • 4) Necessary Transport Authorization (for movement of goods from Manufacturer to Buyer premises) is obtained from Local F.D.A authority is given along with Purchase Order and advance payment to Govt. Opium Alkaloid, so as to enable them to supply the active drug. Based on the availability of drug the Govt. Opium Alkaloid executes the order. The validity of the transport authorization is generally two month within which the order has to be executed. (it takes  8 to 10 days)

  11. 5) Intimation of receipt of drug is given to the State Excise Authority under the provisions of Medicine and Toiler Preparation Act. • 6) The drug is then analyzed (One week) and subjected to manufacturing process so as to obtain the required Morphine tablets to execute the overseas order. • 7) After completion of manufacturing process (15 - 20 days), the necessary transport authorization to transport the finished product from the factory to nearest port of shipment is obtained from the Local F.D.A (10 - 15 days) • 8) The said transport authorization is send to Narcotic Commissioner at Gwalior, for obtained the required NOC to export Morphine tablets from India. • 9) Meanwhile the State Excise duty payable on the finished product is discharged. • 10) On receipt of NOC from The Narcotic Commissioner of India, the goods are released for shipment.

  12. Nishant Dale • Export - Department • Cipla Ltd, Mumbai • Ph: +91-22-23025601 • Mobile: +91 – 9930964677

  13. Oral morphine production in Nepal • Explore the possibility of production oral morphine in Nepal. • Discussion with Nepalese drug company

  14. Oral morphine production in Nepal • Sharing of morphine consumption data • Humanitarian approach • Business nationally & (Internationally!)

  15. Oral morphine production in Nepal National Healthcare Ltd. ,Nepalese Drug Company willing start manufacture of oral morphine when we assured help from government side.

  16. Steps • They applied to Department of Drug Administration (DDA) for manufacturing license of morphine syrup. • 6 months duration of stability testing • National Medicine Laboratory • Marketing license

  17. Oral morphine production in Nepal • Morphine syrup in 2009

  18. Oral morphine production in Nepal Starting manufacturing immediate release morphine tablet since 2011.

  19. New problem • 200,000 morphine SR tabs imported in August 21st 2008, with expiry date July 2011 • Stock balance 97,130 in July 15th,2011

  20. SR morphine production in Nepal Commitment to continue production of immediate release tablet. Morphine SR Tablet in 2012.

  21. Morphine Tab(10mg) PR

  22. Morphine Tab 30mg (PR)2012

  23. Morphine sulphate • Switzerland • Iran • India

  24. Nepalese Association of Palliative CareNAPCare 22 representatives from 13 different institutions had joint meeting in July 2009 NAPCare Officially registered 16th December, 2009 and 11 member body was formed.

  25. Groups involved to form NAPC 1)Bir Hospital 2)Bhaktapur Cancer Hospital 10)Hospice Nepal 3)TU Teaching Hospital 11)Nepal Institute of Health Science 4)Stupa Community Hospital 12)B.P.K.M. Cancer Hospital 5)BPKM Cancer Hospital 13)Sechen Hospice 6)OM Hospital 7)Pashupati Aryaghat Service Center 8)Thankot Hospice Center 9)Nepalese Network Cancer Treatment and Research

  26. Nepalese Association of Palliative Care

  27. Knowledge & Attitude Educational activities for medical staff at major hospitals and hospices on pain relief and palliative care. Cancer pain Relief topic was included in March 2010 National Cancer Conference & first ASCO MCMC course.

  28. Educational activities Four weeks training in 2009 in capital six weeks training in 2010 & 2011 out of capital

  29. Dr. Eric in Nepal to support different activities

  30. Fellow talking about Pain

  31. Palliative care conference(2009)

  32. Prescription Form for morphine & opiods

  33. Annual consumption morphine in Nepal Year Morphine in KG 2007 1.08935 2008 2.57785 2009 4.04325

  34. Conclusion • All forms of morphine available in Nepal • People are working jointly • Knowledge and awareness of regarding opioid use has been improving.

  35. THANK YOU

More Related