Organizational barriers in opioid use.

Despite the fact that we have both the means and the knowledge to ameliorate most forms of pain effectively, a significant number of cancer patients still experience unacceptable levels of pain. This paper sets out to explore the nature of the various organizational barriers to effective pain management. There is ample evidence to demonstrate that both physicians and nurses lack knowledge regarding modern methods of pain control. This situation not only results in poor clinical decision making, but has also spawned a number of extraordinary myths and misconceptions about the use of opioids. Such myths and misconceptions often result in significant undermedication of the patient's pain. Problems can also exist with continuity of care--the patient may be seen by a number of different physicians across a number of different health care settings where no one person is willing to take responsibility for the overall management of the patient's pain. Further fragmentation can occur due to lack of communication between the hospital and the community care setting. This problem can be compounded by incomplete and inconsistent documentation of pain. An important and often overlooked problem relating to opioid use is the existence of bureaucratic regulations governing the supply, prescription and administration of opioids in many countries world wide. There appears to be a real fear that liberalizing many of these regulations will result in an increase in illicit drug use. This paper will conclude with a discussion on ways in which the above-mentioned organizational barriers can be overcome.