Hot Topic: Global Trends in the Use of Opioid Analgesics
- 70 Downloads
Purpose of Review
This study aimed to contribute to the debate on the availability of opioids for pain management by comparing regional and global trends for controlled strong opioids most commonly used for pain over the past 21 years. We conducted a series of analyses on the use of 12 opioids, with a focus on fentanyl, hydrocodone, hydromorphone, morphine, and oxycodone over the 21-year period of 1995–2015, at a regional and global level with country-level data, using random intercept mixed models to assess for change over time and interactions, and controlling for country economic development.
Despite the sufficient supply of opioids to cover global demand, potent opioid pain medications are not available in many regions of the world. Prices of basic off-patent opioid formulations are significantly higher in poor countries as compared to lowest global prices, whilst countries may be under pressure to acquire expensive formulations. This results in lower availability of opioids for pain management in lower-income countries.
The analysis shows that, when adjusted for country-level gross domestic product (GDP) per capita and Human Development Index (HDI) category, the most significant trends in opioid consumption for pain management are those of morphine and fentanyl. Whilst the trend for use of morphine has remained relatively stable, fentanyl use has risen sharply in the past 21 years, even in regions where the levels of overall opioid availability are inadequate or very inadequate. The trends vary according to different regions of the world.
KeywordsOpioid Analgesia Pain management Palliative care Morphine Fentanyl
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
The views expressed herein are those of the authors and do not necessarily reflect the views of the United Nations.
- 1.International Narcotics Control Board. Availability of internationally controlled drugs: ensuring adequate access for medical and scientific purposes. Indispensable, adequately provided and not unduly restricted. New York: United Nations; 2015.Google Scholar
- 3.United Nations Office on Drugs and Crime. Outcome document of the 2016 United Nations general assembly special session on the world drug problem. New York: United Nations; 2016.Google Scholar
- 5.Pastrana T, Wenk R, Radbruch L, Ebtesam A, De Lima L. Pain treatment continues to be inaccessible for many patients around the globe: second phase of opioid Price watch, a cross-sectional study to monitor the prices of opioids. J Palliat Med. 2016, 20(4).Google Scholar
- 8.McPherson ML. Demystifying opioid conversion calculations. Bethesda: ASHP; 2010.Google Scholar
- 9.International Narcotics Control Board. Narcotic drugs 2008: estimated world requirements for 2009—statistics for 2007. New York: United Nations; 2008.Google Scholar