The Global Disparity in Access to Morphine: A Call for Balanced Policies
The World Health Organization (WHO) has recently released a new report on
the global distribution and access to morphine for medical use. The report,
titled “Left Behind in Pain,” sheds light on the unequal distribution of
morphine, a life-saving pain reliever, and emphasizes the urgent need for
balanced policies to improve safe access to this essential medicine.
The Inequality in Access to Morphine
Despite morphine being included in the WHO Model List of Essential Medicines
since 1977, the report reveals a significant disparity in access between
countries. The estimated mean morphine consumption ranges from 5 to 63 times
higher in high-income countries compared to lower-income countries. This
discrepancy is not solely limited to wealthier nations; there are also notable
variations in consumption patterns among countries of similar economic status.
These statistics indicate that the global distribution of morphine does not
align with medical necessity, as it fails to adequately address the pain and
suffering experienced by individuals with terminal illnesses.
The Hidden Inequalities in Global Health
The findings of the WHO report are consistent with the Lancet Commission 2018,
which also highlighted the lack of access to painkillers as one of the most
egregious and hidden inequalities in global health. Shockingly, the richest 10%
of countries own 90% of the morphine-equivalent opioids distributed worldwide.
These staggering numbers underscore the urgent need for action to ensure that
effective medications, such as morphine, are readily available to alleviate
pain and suffering, particularly in the context of end-of-life care.
The Call for Balanced Policies
Dr. Yukiko Nakatani, the WHO Deputy Director-General for Medicines and Health
Products, emphasizes the importance of policymakers addressing the issue of
leaving people in pain when effective medications are available. To achieve
safe and timely access to morphine, balanced policies must be advocated for
worldwide. Such policies should consider the following factors:
-
Facilitators of access: Good governance, reliable procurement and supply
processes, resource availability, and capacity-building activities. -
Barriers to access: Overly restrictive legislation and policies, inadequate
service delivery, misinformed attitudes and perceptions, and excessively
burdensome requirements that impede patient access to morphine.
Opportunities for Action
The report provides recommendations for enhancing safe access to morphine,
including:
-
Implementing small-scale regional or state programs that align with the WHO
Model List of Essential Medicines and promote essential palliative care
services and products. -
Improving governance and streamlining procurement and supply processes to
eliminate inefficiencies. -
Securing stable funding for resources, such as morphine, to ensure its
availability in healthcare facilities. -
Enhancing the skills of healthcare professionals in managing and administering
morphine effectively and safely. -
Raising awareness among healthcare providers and the general public about
the benefits and potential risks of opioid use.
Exploring the Complexity of Morphine Access
While the report sheds light on the disparities in accessing morphine for
medical use, it is crucial to understand the underlying factors that contribute
to this complexity. Access to morphine is influenced by a multitude of interacting
elements, including facilitators and barriers in different country contexts.
For instance:
-
Limited funding poses a significant barrier to access in low- and middle-income
countries, resulting in irregular supply of morphine and other strong opioids in
healthcare facilities. -
Legislative and regulatory factors can impede patient access if the requirements
are excessively restrictive, hindering the flow of supply and making prescribing
and dispensing challenging for healthcare professionals. -
Concerns about the potential harmful effects of opioids, such as their association
with opioid use disorder, necessitate caution and well-informed decision-making
regarding their use in chronic non-cancer pain. However, this should not overshadow
the undeniable benefits of opioid use when clinically indicated and safely
administered by trained professionals.
Bringing Balance and Equity to Morphine Access
Achieving balanced policies and equitable access to morphine demands collaboration
and cooperation among all stakeholders at national, regional, and global levels.
It requires a comprehensive approach that addresses economic disparities, removes
barriers, and promotes education and awareness. By implementing the recommended
actions outlined in the WHO report, governments, healthcare systems, and organizations
can ensure that this life-saving pain reliever reaches those who need it the most,
without compromising patient safety or exacerbating the risks associated with its use.
Summary
The recent WHO report on access to morphine for medical use highlights the alarming
global disparity in morphine distribution. Despite its inclusion in the WHO Model
List of Essential Medicines, the access to morphine varies significantly between
countries, with higher-income nations having significantly higher consumption rates
compared to lower-income countries. This discrepancy in access fails to meet medical
needs and leaves many individuals suffering from pain needlessly. The report emphasizes
the urgent need for balanced policies to ensure safe and timely access to morphine,
particularly in the context of end-of-life care.
To bridge this gap in access, the report suggests implementing small-scale regional
or state programs aligned with the WHO Model List of Essential Medicines, improving
governance and procurement processes, securing stable funding, enhancing healthcare
professionals’ skills, and raising awareness about the benefits and potential harms
of opioid use. However, while addressing these challenges, it is essential to consider
the complexity of morphine access, including factors such as limited funding, legislative
and regulatory barriers, and concerns about opioid use disorder.
Achieving balanced policies and equitable access to morphine requires collaboration
and cooperation among all stakeholders. By taking comprehensive action and implementing
the recommended measures, governments, healthcare systems, and organizations can ensure
that morphine reaches those in need, without compromising patient safety or exacerbating
the risks associated with its use.
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The World Health Organization (WHO) has published a new report on access to morphine for medical use, which describes how the global distribution of morphine, as a life-saving pain reliever, is unequal and does not meet medical needs. The report, titled “Left Behind in Pain,” highlights access issues to this essential medicine and offers actions to improve safe access through balanced policies.
Although morphine is an effective and relatively low-cost medicine to relieve severe pain, included since 1977 in the first edition of the WHO Model List of Essential Medicines, the disparity in access between countries is marked. There’s a Difference from 5 to 63 times in estimated mean morphine consumption between high-income and lower-income countries.
The consumption pattern varies significantly between countries of similar wealth; does not correspond to a medical necessity, as indicated by the estimated number of days that people experience pain or severe respiratory distress for people with a terminal illness.
These data echo those of Lancet Commission 2018 which described lack of access to painkillers as “one of the most egregious and hidden inequalities in global health”, with the richest 10% of countries owning 90% of the morphine-equivalent opioids distributed.
“Leaving people in pain when effective medications are available to control pain, especially in the context of end-of-life care, should be of serious concern to policymakers,” says Dr. Yukiko Nakatani, WHO Deputy Director-General for Medicines and Health Products. “We must urgently advocate for safe and timely access to morphine for those with medical needs through balanced policies everywhere.”
Reasons for the disparity
Access to morphine for medical use is influenced by many interacting factors, including facilitators related to good governance, reliable and efficient procurement and supply processes, resource availability and capacity-building activities, along with barriers related to overly restrictive legislation and policies, inadequate service delivery, and misinformed attitudes and perceptions.
Given different country contexts, enablers, obstacles and priorities for action vary; A stakeholder survey presented in this report, with respondents from 105 WHO Member States, confirms this variation. For example, irregular supply of morphine and other strong opioids in health facilities due to limited funding was commonly considered a barrier in low- and middle-income countries compared to high-income countries. 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 to achieve safe access. Unduly restrictive requirements could hinder patient access by impeding the flow of supply or making prescribing and dispensing difficult for healthcare professionals.
It is important to note that concerns about the potential harmful effects of opioids are valid, such as their potential to cause opioid use disorder. For this reason, some caution about the potential harms of opioid use (e.g., use in chronic non-cancer pain) is important for public health to the extent that their use is well-informed and proportional to the risks. risks. These concerns should not undermine the benefits of opioid use when clinically indicated and when used safely by trained professionals.
Opportunities for action
The report presents a complementary set of action areas that aim to improve safe access to morphine. These include the implementation of small-scale regional or state programs to improve access to morphine for medical use with a package of essential palliative care services and products formulated in accordance with the WHO Model List of Essential Medicines and the Essential Package of Palliative Medicines of the WHO. Careful. They also include improving governance, streamlining procurement and supply processes to address any inefficiencies, improving resources such as stable funding, improving the competent skills of healthcare personnel, and raising awareness about the benefits and potential harms of opioid use. The success of these actions will depend on collaboration and cooperation between all interested parties at the national, regional and global levels.
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