Feast or Famine: The World's Opioid Gap
How can we get opioids to patients who need them?
Opioids remain one of the most valuable tools for relieving chronic and acute pain, yet the World Health Organization estimates that more than 5 billion people worldwide live in countries with little or no access to opioid pain management. This includes millions of people suffering from terminal cancer and acute illnesses.1
In a 2014 review of availability and utilization of opioids for pain management, published in The Ochsner Journal, the authors noted that 6 developed countries accounted for 79% of the world's opioid consumption. They also noted that severe and chronic pain adversely affects more lives worldwide than diabetes, heart disease, and cancer combined.2
According to an international study published in the February issue of The Lancet, worldwide use of common opioid painkillers more than doubled between 2001-2003 and 2011-2013.3
However, 95.7% of that increase occurred in North America, Western and Central Europe, Australia, and New Zealand — which together account for about 15% of the world's population.
No substantial effect was observed with respect to opioid use or access in the rest of the world.
“The situation has changed so little in regions with low-income and middle-income countries that improvement remains unlikely in the absence of specific strategies to deal with the impediments to increased availability,” write Stefano Berterame, PhD, from the International Narcotics Control Board in Vienna, Austria, and colleagues.
Areas in which chronic and severe impediments to opioid access still exist were identified in Africa, Asia, Central America, the Caribbean, South America, and Eastern Europe.
The Opioid Epidemic in Developed Countries
“The belief that doctors were not adequately providing pain relief has been a major contributing factor in our pain prescription and heroin epidemics,” Alan David Kaye, MD, PhD, told Clinical Pain Advisor. Dr Kaye, coauthor of the 2014 review, is a professor and chair of anesthesiology at Louisiana State University Health Sciences Center in New Orleans, Louisiana.
“If you look at a number of recent studies, it turns out that, at present, only the smallest percentage of prescription pain killers are written by pain specialists,” Dr Kaye pointed out.
Opioid abuse and overuse is starting to be recognized and addressed in developed counties. “It is surprising that countries have been so slow to act and [that] there has been little, if any, international collaboration to address the opioid epidemic, said Dr Kaye. “I think this is starting to change,” he added.
But will a shift toward more judicious use of opioids open the floodgates to more availability in the developing world?
“Lack of availability in developing countries is not due to lack of raw material and overuse by developed countries — the reason has to do with the limited capacity of developing countries to ensure opioid analgesics are made available. Therefore, while overconsumption in developed countries is a problem per se, it is not the origin of the lack of availability in other areas,” Dr Berterame told Clinical Pain Advisor.