Access to opioids for pain relief in developing countries

October 26, 2015

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A new report issued by the Global Commission on Drug Policy states that drug control systems have been a major barrier to access to opioids for pain relief in low and middle income countries. The Commission calls for a new global initiative to ensure access to controlled drugs by removing domestic and international obstacles. This initiatieve should be led by the World Health Organization.

According to Michel Kazatchkine, the UN Secretary General’s special envoy on HIV/AIDS in Eastern Europe and Central Asia and a member of the Commission, 150 of 190 countries (comprising 5.5 billion people) have very little or no access to opiates for pain relief. At the last estimate, 92% of the world’s supply of morphine was consumed by just 17% of the global population, primarily those in the Global North. In an interview with the BMJ, Mr. Kazatchkine said: “This is directly and indirectly a consequence of the current international drug control regime. The regime has been interpreted in a very imbalanced way so that repression and prohibition really dominate. What we hope is that first, people will acknowledge the debate should be opened based on evidence and second, that the initiative that we’re proposing would bring everyone together despite differences. We need a shift in drug policies towards putting health and human rights as a priority.”

Climate of fear

The report also recommends that governments establish clear paths to remove barriers to ensuring access to controlled drugs. In many countries doctors operate in a climate of fear, afraid of prescribing controlled drugs due to the risk of prosecution, fuelled by non-acceptance and ideological beliefs. The lack of clinical education and training for healthcare workers also is a major obstacle to the proper provision of controlled drugs. Jason Nickerson, a global health expert from the University of Ottawa, said that clinicians in low and middle income countries must be trained to know how to use such drugs effectively to manage people’s pain. “Part of this means shifting the conversation from talking about ‘drugs’ to talking about medicines – because that’s what morphine is: it’s a medicine. And it is one that billions of people currently have no access to.”

Right to access to pain relief

These opinions are in line with IFHHRO’s views on this matter. We believe that the right to access to pain management for all people should be respected and effectively implemented. In 2011, we issued a position statement on access to pain relief in four languages. It states among others that instruction on pain management should be included in all mandatory medical and nursing curricula, and that countries should review their drug control policies and regulations to ensure that they do not contain provisions that unnecessarily restrict the availability and accessibility of controlled medicines for the treatment of pain.


“Remove policies that restrict access to opioids in developing countries, says report”. BMJ 2015, 351, h5540, 19 October 2015

The Negative Impact of Drug Control on Public Health: The Global Crisis of Avoidable Pain. Global Commission on Drug Policy, 2015