Global Disparities in Pain Management

The Annals of Oncology recently published a supplement (2013, volume 24, supplement 11;

http://annonc.oxfordjournals.org/content/24/suppl_11?etoc) on the results of the first global study of the availability and barriers for accessing opioids to treat cancer pain. Not surprisingly, many patients are not receiving adequate pain control because of regulatory restrictions and lack of access and availability. It is estimated that 5 billion people live in countries with little or no access to adequate pain relief.

One report in the supplement was initiated by the European Society of Medical Oncology (ESMO), working in collaboration with the European Association of Palliative Care (EAPC), the Pain and Policies Study Group at the University of Wisconsin Carbone Cancer Center in Madison, the Union for International Cancer Control (UICC), and the World Health Organization (WHO). These groups collaborated with local and regional partners to collect data on access and barriers. The survey evaluated 79 countries and 25 Indian states, representing 87% of the global population. In Africa, Asia, the Caribbean, Latin America, and the Middle East, the ESMO and its partners assessed the availability of the 7 opioids designated to be essential for the relief of cancer pain by the WHO Model List of Essential Medicines and the International Association for Hospice and Palliative Care: codeine, oral oxycodone, transdermal fentanyl, immediate- and slow-release oral morphine, injectable morphine, and oral methadone. Many disparities between developed and developing countries were observed. Four countries (USA, Australia, Canada, and the UK) use 69% of the world’s opioids, and developing countries used just 7%. This of course does not mean that opioids are being over-prescribed in the USA. Instead, the data suggest that they are being under-utilized in developing countries because of problems with accessing opioids and regulations that while well-intended, are actually preventing patients in developing countries from receiving the pain control that they need—and deserve to receive.