The other opioid crisis: the situation in low-resource countries
Journal – Canadian Journal of Anesthesia
Article type – Journal research article – Other
Publication date – Jul – 2022
Authors – Clare Roques, Wayne Morriss, Carolina Haylock-Loor
Keywords – low- and middle-income countries (LMICs), opioid crisis, Palliative Care and Pain Relief (LCPCPR)
Open access – Yes
Speciality – Anaesthesia
World region Global
Language – English
Submitted to the One Surgery Index on August 2, 2022 at 3:08 am
Numerous articles in this Special Issue describe an opioid crisis where there is too much opioid, especially in Canada, the USA, and some other high-income countries. Nevertheless, for the majority of the world’s population—people living in low-resource countries—the problem is not enough opioid. In most of the world’s countries, patients are living and dying in severe pain because of limited or no availability of opioid medications.
The scale of the crisis
The World Health Organization (WHO) estimates that 80% of the world’s population (5.5 billion out of 7 billion people) have insufficient access to controlled medications to treat moderate-to-severe pain.1 This is despite morphine, fentanyl, and methadone being included in the WHO’s Model List of Essential Medicines.2 All countries are required to submit yearly opioid usage data to the International Narcotics Control Board, and recently collated data show that low- and middle-income countries (LMICs) used only 10% of the world’s ids. In comparison, a handful of high-income countries (Canada, the USA, Australia, New Zealand, and some European countries) consumed over 90%.3 This means that patients in most of the world are unable to access appropriate, effective treatment for the management of acute pain or pain at the end of life, leading to extreme levels of avoidable suffering.
The Lancet Commission on Palliative Care and Pain Relief (LCPCPR) published a report in 2017 detailing the global problem of low access to opioids and describing an “access abyss” for those living in low-resource areas.4 The authors estimated that in 2015 over 60 million people were suffering from symptoms that needed palliative care and pain relief. In low-resource countries, the situation is made worse because of the combination of low availability of medications and increased burden of pain due to undertreatment and late presentation of many conditions such as cancer and HIV/AIDS. This is illustrated by the Figure, showing a world map where the areas of countries are distorted in proportion to their opioid use divided by their burden of painful disease.4 Canada and the USA are vastly enlarged while other parts of the world (such as Africa and parts of Asia) are barely visible.
OSI Number – 21696