Use of and barriers to access to opioid analgesics worldwide

Use of common opioid painkillers such as codeine, morphine and oxycodone has more than quadrupled in Australia over the past decade and doubled worldwide over the same period a report published today in The Lancet by the International Narcotics Control Board (INCB) reveals. Yet at the same time the authors warn that the majority of countries, particularly those in developing and poorer regions have little or no access to basic pain medication and there has been little change over the decade.

A research team from the INCB including Professor Richard Mattick of the National Drug and Alcohol Research Centre at UNSW Australia calculated the daily use of opioid analgesics for countries and regions globally over the period 2001 to 2013, compared the data against the prevalence of health conditions requiring pain relief and surveyed 214 countries about any impediments to availability of the medications.

The authors found that the bulk of the increase occurred in high income western countries and regions including North America, Western and Central Europe and Australia and New Zealand, which together accounted for more than 95 per cent of global opioid use. In Australia use of the medications increased more than four-fold from 3,287 doses per day per million (22 million doses annually) to 13,440 doses per day per million (106 million doses). The needs of the ageing population for cancer pain and increased pain management for chronic non-cancer pain in Western countries are thought to be the main drivers of the increase. As there is no recognised level of appropriate prescribing, it is not known if this use is excessive or appropriate.

By contrast, the majority of poorer and less developed nations including Central America and the Caribbean, Africa, South Asia, East Asia, South East Asia and Eastern Europe had little or no access to opioid pain relief and there had been no significant increase in use in these regions over the period. Over five and a half billion people are estimated to have little or no access to essential pain relief.

"Much of the increased usage that has occurred in high income countries is probably partly due to long term prescribing for non-cancer pain but the absence of real growth in most of the world indicates an ongoing lack of provision of these essential medications," write the authors.

They also caution that increased access will not necessarily lead to misuse but that a balance must be maintained.

"Ensuring access does not necessarily mean increased abuse and diversion, but it is necessary to maintain a balance between control on the one hand, and overly liberal availability on the other," the authors write. "Countries can review legislation and regulatory systems to remove unduly restrictive provisions, while still preventing diversion."

The authors warn that the lack of access in developing nations is highly inequitable and is in contravention of international agreements such as the Universal Declaration of Human Rights which includes the right to medical care including palliative care and the United Nations Convention.

The paper found that the low levels of prescribing in poorer developing countries did not reflect the need for the medications. For example data from the International Agency for Research on Cancer shows that more than half of all cancer cases and cancer deaths occurred in less developed regions. "In these regions the disease is mostly discovered when it is at an advanced stage... By then palliation is often required and access to opioid analgesics is essential," the authors write. Levels of prescribing of opioid painkillers are also well below what is needed to manage AIDS related pain in developing regions, in particular Sub-Saharan Africa and Asia, the report finds.

The authors found that barriers to use in poorer and developing countries included affordability, lack of awareness and training among medical professionals, fear of dependence, limited financial resources, problems in sourcing, fear of misuse and onerous regulations.

Professor Mattick, senior author on the paper said that the correct level of opioid use was unclear. "The ageing populations and greater care for chronic non-cancer pain are likely drivers of increased use in high-income countries," he said. However in lower income developing countries it was clear the low levels of prescribing did not reflect the need for the medications. "The lack of availability of these medications in low-income countries for the management of cancer pain is a terrible situation causing massive suffering," said Professor Mattick.

The report will be available for the Commission on Narcotic Drugs of all countries in March in Vienna and the UNGASS (UN General Assembly Special Session on the World Drug Problem) in New York in April.

Most Popular Now

Merck invests € 250 million in production value ch…

Merck, a leading science and technology company, today inaugurated its € 170 million Nantong pharmaceutical plant, which is dedicated to producing high-quality pharmaceut...

Read more

Roche launches imCORE, a global network of cancer …

Roche (SIX: RO, ROG; OTCQX: RHHBY) has launched the global cancer immunotherapy Centers of Research Excellence (imCORE™) Network. This network brings together many of the...

Read more

New research shows promise for immunotherapy as HI…

Immunotherapy has revolutionized treatment options in oncology, neurology, and many infectious diseases and now there is fresh hope that the same method could be used to ...

Read more

15th Annual eyeforpharma Philadelphia 2017

20 - 21 April 2017, Philadelphia, USA. It's eyeforpharma Philadelphia's 15th year; already the largest, most senior and most influential forum for commercial pharma exec...

Read more

Pancreatic cancer set to become third biggest canc…

The number of deaths from pancreatic cancer will overtake breast cancer mortality rates in the EU in 2017, a study has found. The findings, recently presented at UEG Week...

Read more

Merck wins R&D 100 Award for top invention

Merck, a leading science and technology company, received a prestigious R&D 100 Award for its Sanger Arrayed Lentiviral CRISPR Libraries - the first of its kind CRISPR li...

Read more

Regorafenib from Bayer submitted to health authori…

Bayer has announced the submission of applications to extend the marketing authorization for its oral multi-kinase inhibitor regorafenib in the U.S., Japan and Europe, fo...

Read more

Researchers discover way to inhibit major cancer g…

Researchers at the University of Illinois at Chicago have identified a new way to block the action of genetic mutations found in nearly 30 percent of all cancers. Mutatio...

Read more

Genetically engineering disease-fighting cells

The human body produces T cells to recognize and fight disease. Each T cell has a unique T cell receptor (or TCR) on its surface that surveils small fragments of proteins...

Read more

New European study highlights differing priorities…

Results from a survey analysing the prescribing behaviour of 500 European physicians treating patients with advanced non-small cell lung cancer (NSCLC) have been publishe...

Read more

Benzodiazepine and related drug use increases hip …

The use of benzodiazepines and related drugs increases the risk of hip fracture by 43% in persons with Alzheimer's disease, according to a new study from the University o...

Read more

Among antidementia drugs, memantine is associated …

A recent study from the University of Eastern Finland shows that among users of antidementia drugs, persons using memantine have the highest risk of pneumonia. The use of...

Read more

Pharmaceutical Companies

[ A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Z ]