C5 - Managing pain – A delicate balancing act

Auditorium 3

Organised by the FIP Hospital Pharmacy Section in collaboration with FIP’s Community Pharmacy Section & FIP's Expert Group on Ethics


Rebekah Moles, The University of Sydney, Australia and Shane Jackson, The University of Tasmania, Australia


Assisting in Managing Patient Pain is a vital part of the pharmacist’s role in both hospital and community settings. In many developed countries, there is a current epidemic in overuse and misuse of opioid analgesics and restriction of over the counter analgesics has recently occurred in some countries. On the flip side, due to the stigma associated with opioid use in other parts of the world, many patients’ pain is undertreated. The lack of supply of these agents for some is seen as cruel as it causes unnecessary suffering. Others debate that the free use of these agents is also not warranted as the abuse potential is so high. The balancing act between appropriate treatment and abuse will be debated in this session. We will discuss the pros and cons of the restrictions of these important analgesic agents and whether pharmacists should be at for-front of controlling their use. This session will be run as a debate, followed by a panel discussion.


  1. Opioids should be tightly restricted and used sparingly – Arguments for tighter restrictions
    Neil MacKinnon, University of Cincinnati, USA
  2. Tight restrictions means people are undertreated
    Cherian Varghese, World Health Organization, India
  3. The up-scheduling of codeine – An Australian case study
    Natasa Gisev, National Drug and Alcohol Research Centre, Australia
  4. Please don’t take codeine away – We can do a good job
    Roger Knaggs, University of Nottingham, UK
  5. The way forward – The role of pharmacists to ensure appropriate use through opioid stewardship
    Jonathan Penm, The University of Sydney, Australia
  6. Fishbowl discussion with Q/A

Learning Objectives

At the end of this session, participants will be able to:

  1. Explain the issues facing developed countries with respect to the opioid abuse crisis and current restriction policies
  2. Appreciate the issues facing some developing countries with respect to undertreatment of pain
  3. Discuss the impact that up-scheduling of over the counter opioid therapies have had on pharmacy practice
  4. Advocate for an expanding role of pharmacists in pain management and opioid stewardship

Type of session: Application-based