Thank you, Neil, for sharing these questions with us.
I want to address one topic in particular: Are healthcare professionals in Latin America aware of the problematic signs of opioid use and do they know how to manage this issue?
The limited evidence available points to variable and frequently insufficient knowledge.
Specialist physicians (psychiatrists, addiction specialists, emergency medicine specialists) have been trained and therefore generally recognize the symptoms and can, in general, manage them. But in the rest of the system, including primary care and other specialties, underdiagnosis is common.
As I have mentioned on several occasions, since Latin America is not immersed in an “opioid abuse epidemic” like the US, specific training on this problem receives less attention.
Professionals are usually better informed (but not always adequately informed or trained) to recognize problems related to the use of other substances such as alcohol, tobacco, and cocaine/crack cocaine.
Training healthcare professionals on opioids is not a training priority in our region. As a professor once said to me, “You search, and sometimes you find, what you already know.” If we are not properly informed, we may fail to recognize the problem or recognize it too late.
Therefore, in Latin America, the problem is not only clinical, it is systemic:
- Lack of training
- Lack of protocols
- Inadequate training of primary care personnel
- Lack of adequate access to treatment (e.g., methadone, buprenorphine) in some countries.
In short, in Latin America, while information on the clinical signs of opioid use disorder is available in medical literature, its recognition in practice is inconsistent and very likely poor or delayed.
Most healthcare professionals have not received systematic training, which leads to underdiagnosis and, eventually, delayed treatment.
Strengthening training in primary care should be a priority in our region if we want to be prepared to identify and address a potential “opioid epidemic” in its early stages.
For this reason, the Pan American Health Organization (PAHO) emphasized the critical need to strengthen human resources for health (HRH) in addiction treatment, particularly through the Strategic Plan 2026-2031 and the Policy on the Health Workforce 2030.
PAHO stated: addressing the shortage and skill gaps in addiction specialists is essential to improve care for substance use disorders in Latin America and the Caribbean.
The PAHO Key Areas for Strengthening Addiction Workforce (2026) are:
- Integrating Primary Care: Strengthening the ability of primary care teams to detect and manage substance use disorders, reducing reliance on specialized, hospital-based care.
- Improving Training and Capacity: Expanding skills in evidence-based treatments and addressing the need for training in interprofessional teams, particularly in rural or underserved areas.
- Addressing Workforce Shortages: Tackling the shortage of nearly 800,000 health workers, with a focus on retention and professional development for mental health and addiction professionals.
- Dual Diagnosis Focus: Promoting specialized training for "dual diagnosis" (simultaneous mental health and substance use disorders).
References:
Arya S, Delic M, Ruiz BII, Klimas J, Papanti D, Stepanov A, Cock V, Krupchanka D. Closing the gap between training needs and training provision in addiction medicine. BJPsych Int. 2020 May;17(2):37-39.
PAHO. Policy on the Health Workforce 2030: Strengthening Human Resources for Health to Achieve Resilient Health Systems. https://www.paho.org/en/documents/policy-health-workforce-2030-strengthe...
Kind regards,
Eduardo
Eduardo Bianco, MD, MSc, BIR
ATHP Director
Addiction Training for Health Professionals <https://athp.nextgenu.org/>
Email: ebianco@nextgenu.org
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Master's in Prevention and Treatment of Addictive Disorders. Bianco also has a degree in International Relations. Currently, he is Director of International Policy Education in Addictions of the Frank Foundation for International Health and Member of the Interim Policy Committee of the Global Alliance for Tobacco Control (GATC). He had a prominent role in promoting smoking cessation, tobacco control, WHO-FCTC implementation and NCD control in his country (Uruguay) as well as in Latin America for over 25 years. Bianco participated directly in most of the development process of the WHO-Framework Convention on Tobacco control and in the Sessions of the Conference of the Parties to this treaty. He was Director or Tobacco Control Program of InterAmerican Heart Foundation, Regional Coordinator for the Americas of the Framework Convention Alliance (FCA), Chair of the Tobacco Expert Group of the World Heart Federation and Technical Director of the MOH Center for International Cooperation for Tobacco as well as Founder and Former President of the Tobacco Epidemic Research Center (CIET) in Uruguay. Eduardo helps coordinate the HIFA working group on substance use disorders. https://www.hifa.org/support/members/eduardo