Global Supply and Demand of Opioids for Pain Management

  • Sreekumar Kunnumpurath
  • Natasha Julien
  • Gopal Kodumudi
  • Anamika Kunnumpurath
  • Vijay Kodumudi
  • Nalini Vadivelu
Other Pain (A Kaye and N Vadivelu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Other Pain


Purpose of Review

The goal of this review is to evaluate the global supply and demand of opioids used for pain management and discuss how it relates to the utilization of opioids around the world. The purpose of the review is also to determine the factors that contribute to inappropriate pain management.

Recent Findings

The total global production of opium for opioid manufacturing is enough to supply the growing global demands. However, licit opioids are only consumed by 20% of the world population. Most people throughout the world had no access to opioid analgesics for pain relief in case of need. Opioid misuse and abuse is not only a phenomena plague by the USA but globally across many countries.


Many countries have a lack of availability of opioids, contributing factors being strict government regulations limiting access, lack of knowledge of the efficacy of opioid analgesics in treating acute and chronic pain and palliative care, and the stigma that opioids are highly addictive. For the countries in which opioids are readily available and prescribed heavily, diversion, misuse, abuse, and the resurgence of heroin have become problems leading to morbidity and mortality. It is pertinent to find a balance between having opioids accessible to patients in need, with ensuring that opioids are regulated along with other illicit drugs to decrease abuse potential.


Opioid analgesics Global opioid supply Global opioid demand Pain management Prescription opioids Opioid 


Compliance with Ethical Standards

Conflict of Interest

Sreekumar Kunnumpurath, Natasha Julien, Gopal Kodumudi, Anamika Kunnumpurath, Vijay Kodumudi, and Nalini Vadivelu declare no conflict 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.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Duvivier H, Gustafson S, Greutman M, Jangchup T, Harden AK, Reinhard A, et al. Indian Health Service pharmacists engaged in opioid safety initiatives and expanding access to naloxone. J Am Pharm Assoc. 2017;57:135–40.CrossRefGoogle Scholar
  2. 2.
    •• Buitrago R. Access to opioids: a global pain management crisis. J Pain Palliat Care Pharmacother. 2013;27(1):86–7. This article discusses the standardization of opioid consumption and the establishment that the majority of the global population are condemned to live with low to nonexistent access to opioids. Suggests ways of alleviating the phenomena of the global pain management crisis.
  3. 3.
    •• Narcotic Drugs 2016: Estimated world requirements for 2017—statistics for 2015 supply of opiate raw materials and demand for opiates for medical and scientific purposes United Nations publications. Doi: 10.18356/1b14fad7-en. Discusses the supply of opiate raw materials through the cultivation from opium poppy in various counties and the production of and global stock of opiate raw materials and opioids derived from them. Discusses the global demand for opiate raw materials by manufacturers, demands measured as consumption, and the trends in consumption levels. Google Scholar
  4. 4.
    •• United Nations Office on Drugs and Crimes 2017a. World Drug Report Booklet 2: global overview of drug demand and supply. Latest trends, cross-cutting issues. United Nations Publication. Describes the use of pharmaceutical opioids in pain management, palliative care, and opioid dependence. Recognizes the lack of access to prescription opioids, its misuse in various countries, and supply.Google Scholar
  5. 5.
    United Nations Office on Drugs and Crimes 2017b. World Drug Report Booklet 1: executive summary. Conclusions and policy implication. United Nations Publication.Google Scholar
  6. 6.
    Berterame S, Erthal J, Thomas J, Fellner S, Vosse B, Clare P, et al. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. Lancet. 2016;387:1644–56. Published Online February 3, 2016. Scholar
  7. 7.
    Hempstead K, Yildirim EO. Supply-side response to declining heroin purity: fentanyl overdose episode in New Jersey. Health Economics. 2014;23:688–705. Published online 6 June 2013 in Wiley Online Library ( Scholar
  8. 8.
    Inciardi JA, Surratt HL, Kurtz SP, Cicero TJ. Mechanisms of prescription drug diversion among drug-involved club- and street-based populations. Pain Med (Malden, Mass). 2007;8(2):171–83. Scholar
  9. 9.
    Chandra A, Ozturk A. Health professionals beware of prescription pain medication abuse and diversion. Hosp Top. 2004;82(4):34–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Green TC, Gilbert M. Counterfeit medications and fentanyl. JAMA Intern Med. 2016;176:10.CrossRefGoogle Scholar
  11. 11.
    Kruithof K, Judith A, David DH, Megan ED, Stijn H. Internet-facilitated drugs trade: an analysis of the size, scope and the role of the Netherlands. WODC, Ministerie van Veiligheid en Justitie. 2016. Scholar
  12. 12.
    Global Drug Survey 2017, Detailed findings on drug cryptomarkets. Available from Dr. Monica Barratt, National Drug and Alcohol Research Centre, London, UK.Google Scholar
  13. 13.
    •• Manjiani D, Paul DB, Kunnumpurath S, Kaye AD, Vadivelu N. Availability and utilization of opioids for pain management: global issues. Ochsner J. 2014;14(2):208–15. Discuss some of the barriers to effective pain assessment and management in developed and developing countries, including disparities in opiate production and actual needs. Discuss the delivery of chronic opioid therapy for non-cancer pain management. PubMedPubMedCentralGoogle Scholar
  14. 14.
    Duthey B, Scholten W. Adequacy of opioid analgesic consumption at country, global, and regional levels in 2010, its relationship with development level, and changes compared with 2006. J Pain Symptom Manag. 2014;47(2):283–97. Scholar
  15. 15.
    Seya MJ, Gelders SFAM, Achara OU, Milani B, Scholten WK. A first comparison between the consumption of and the need for opioid analgesics at country, regional, and global levels. J Pain Palliat Care Pharmacother. 2011;25(1):6–18. Scholar
  16. 16.
    Saini S, Bhatnagar S. Cancer pain management in developing countries. Indian J Palliat Care. 2016;4:373–7. Scholar
  17. 17.
    Foley KM, Wagner JL, Joranson DE, et al. Pain control for people with cancer and AIDS. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease control priorities in developing countries. 2nd edition. Washington (DC): the International Bank for Reconstruction and Development / the World Bank; 2006. Chapter 52. Available from: by Oxford university press, N Y.
  18. 18.
    Cleary J, Simha N, Panieri A, Scholten W, Radbruch L, Torode J, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in India: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol. 2013;24:xi33–40.CrossRefPubMedGoogle Scholar
  19. 19.
    Jamison R, Scanlan E, Matthews ML, Jurcik DC, Ross EL. Attitudes of primary care practitioners in managing chronic pain patients prescribed opioids for pain: a prospective longitudinal controlled trial. Pain Med. 2016;17(1):99–113. Scholar
  20. 20.
    Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65(5051):1445–52. Scholar
  21. 21.
    Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid–involved overdose deaths—27 states, 2013–2014. MMWR Morb Mortal Wkly Rep. 2016;65:837–43. Scholar
  22. 22.
    King NB, Fraser V, Boikos C, Richardson R, Harper S. Determinants of increased opioid-related mortality in the United States and Canada, 1990-2013: a systematic review. Am J Public Health. 2014;104(8):e32–42. Scholar
  23. 23.
    Center for Behavioral Health Statistics and Quality 2016. Key substance use and mental health indicators in the United States: results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16–4984, NSDUH Series H-51). Retrieved from
  24. 24.
    Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559–74. Scholar
  25. 25.
    European Monitoring Centre for Drugs and Drug Addiction. European drug report 2017: trends and developments. Luxembourg: Publications Office of the European Union; 2017. ISBN: 978-92-9497-074-9Google Scholar
  26. 26.
    Mohamed NR, El Hamrawy LG, Shalaby AS, El Bahy MS, Abd Allah MM. An epidemiological study of tramadol HCl dependence in an outpatient addiction clinic at Heliopolis Psychiatric Hospital. Menoufia Med J. 2015;28:591–6.CrossRefGoogle Scholar
  27. 27.
    Cicero T, Ellis M. Understanding the demand side of the prescription opioid epidemic: does the initial source of opioids matter? Drug Alcohol Depend. 2017;173:S4–S10. Scholar
  28. 28.
    Beletsky L, Davis CS. Today’s fentanyl crisis: prohibition’s iron law, revisited. Int J Drug Policy. 2017;46:156–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Clark DJ, Schumacher MA. America’s opioid epidemic: supply and demand considerations. Anesth Analg. 2017;125(5):1667–74. Scholar
  30. 30.
    Cahana A, Dansie EJ, Theodore BR, Wilson HD, Turk DC. Redesigning delivery of opioids to optimize pain management, improve outcomes, and contain costs. Pain Med. 2013;14(1:1):36–42. Scholar
  31. 31.
    Tehrani AB, Henke RM, Ali MM, Mutter R, Mark TL. Trends in average days’ supply of opioid medications in Medicaid and commercial insurance. Addict Behav. 2018;76:218–22. Scholar
  32. 32.
    Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624–45. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018
corrected publication April/2018

Authors and Affiliations

  • Sreekumar Kunnumpurath
    • 1
  • Natasha Julien
    • 2
  • Gopal Kodumudi
    • 3
  • Anamika Kunnumpurath
    • 4
  • Vijay Kodumudi
    • 5
  • Nalini Vadivelu
    • 6
  1. 1.Epsom and St Helier Universty HospitalsCarshaltonUK
  2. 2.Department of Anesthesiology Staff AffiliateYale New Haven Hospital, Perioperative Services, Yale School of MedicineNew HavenUSA
  3. 3.California Northstate University College of MedicineElk GroveUSA
  4. 4.Medical School, University College LondonLondonUK
  5. 5.University of Connecticut School of MedicineFarmingtonUSA
  6. 6.Department of AnesthesiologyYale UniversityNew HavenUSA

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