HQ Team
June 17, 2023: Access to pain relief medication, morphine, is ‘one of the most heinous, hidden inequities in global health’ with the richest 10% of countries possessing 90% of distributed morphine-equivalent opioids, according to a WHO report.
“Leaving people in pain when effective medicines are available for pain management, especially in the context of end-of-life care, should be a cause of serious concern for policymakers,” Dr Yukiko Nakatani, WHO Assistant Director-General for Medicines and Health Products said.
“We must urgently advocate for safe and timely access to morphine for those in medical need through balanced policy, everywhere.”
Despite morphine being an effective and relatively low-cost medicine for relieving strong pain, listed since 1977 in the first edition of the WHO Model List of Essential Medicines, the disparity in access across countries was stark.
5 to 63-fold difference
“There is a 5- to 63-fold difference in the estimated median consumption of morphine between high-income countries and lower-income countries,” according to the new report, ‘Left behind in pain.’
Consumption patterns varied significantly across countries of similar wealth. It does not correspond to medical needs, as indicated by the estimated number of days people are in pain or suffer from severe shortness of breath for people with a terminal illness.
Given different country contexts, enablers, barriers, and priorities for action vary; a stakeholder survey presented in the report, with respondents from 105 WHO Member States, confirmed this variation.
Irregular supply of morphine and other strong opioids at health facilities due to limited financing were commonly cited as a barrier in low- and middle-income countries, compared to rich nations.
Regulatory barriers
More than a third of respondents across all regions also noted barriers arising from legislative and regulatory factors while recognizing the importance of a legislative and regulatory framework in achieving safe access.
Undue restrictive requirements could hamper patient access because they impede the flow of supply or make prescribing and dispensing difficult for healthcare professionals.
The report stated the potentially harmful effects of opioids were valid, as they could lead to opioid use disorder.
A certain amount of caution about the potential harms of opioid use, or use in chronic non-cancer pain, was important for public health as long as its use was well-informed and proportionate to risks.
Such concerns should not undermine the benefits of opioid use when clinically indicated, and when used safely by trained professionals.
Competent health workforce
The WHO recommended implementing small-scale regional or statewide programs on improving access to morphine for medical use with a package of essential services and products for palliative care.
The package must be formulated according to the WHO Model List of Essential Medicines and the WHO Essential Package of Palliative Care.
The global health agency suggested improving governance, streamlining procurement and supply processes to address any inefficiency, and improving resourcing such as stable funding.
“Enhancing competent skill sets of the health workforce, and raising awareness about both the benefits and potential harms of opioid use,” would go a long way in finding solutions, according to the report.
“The world is facing two crises related to the use of opioids. In the first, inappropriate use and over-prescription combined with the wide availability of illicit unregulated opioids, such as fentanyl, in some countries is causing significant harm and loss of life,” Dr Yukiko Nakatani said. “In the second, a lack of access to opioids such as morphine in many parts of the world means that millions of people continue to suffer preventable pain.”
