Monday, January 6, 2014

The Critical Lack of Access to Essential Pain Relieving Medications in the Developing World

The European Association for Palliative Care (EAPC) and European Society for Medical Oncology (ESMO) have been speaking out about the lack of access to opioids in developing countries.  The USA consumes 51% of global opioids annually despite having only 5% of the world's population.  Only 5% of opioids (like morphine) are used by 80% of the world's population.  Meaning that most people who have severe pain, from surgery, cancer or other medical illnesses, never get pain relief.  Imagine dying without any medication to relieve your pain.  Imagine watching your child suffer in this way.

Access essential pain relieving medications for children with cancer is a huge problem in Bangladesh. There are very few formulations of opioids available.  The formulations that are available are not suitable for children as the doses are too large (designed for adults).  There are very restrictive policies about which pharmacies can dispense opioids and patients often live hours away from the closest location where they could get opioids.  Doctors are very hesitant to prescribe opioids due to lack of knowledge about how to do so and fears of causing addition.  (Which is not an issue as children need the opioids for pain).

Surprisingly, cost is not a big issue as producing the simplest form of morphine, which would be effective for many children with pain, costs pennies per day.  However, the low cost means that pharmaceutical companies are not interested in producing this type of morphine as there is not much money to be made and there is essentially no demand for the product at this time.

Morphine is on the most recent (April 2013) List of Essential Medicines for Children from the WHO.  It should be available in all countries, so that children who have pain do not have to suffer.

New global study led by ESMO reveals a pandemic of intolerable pain affecting billions, caused by over-regulation of pain medicines

Lugano, Switzerland –- A ground-breaking international collaborative survey, published today in Annals of Oncology, shows that more than half of the world’s population live in countries where regulations that aim to stem drug misuse leave cancer patients without access to opioid medicines for managing cancer pain.
The results from the Global Opioid Policy Initiative (GOPI) project show that more than 4 billion people live in countries where regulations leave cancer patients suffering excruciating pain. National governments must take urgent action to improve access to these medicines, says the European Society for Medical Oncology, leader of a group of 22 partners that have launched the first global survey to evaluate the availability and accessibility of opioids for cancer pain management.

This graph shows the global distribution of morphine consumption vs. percentage of world population.  More than 4 billion people live in the countries which use only 5% of global morphine supply. 

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