Abstract
Also published as Chapter 19 in: M. Hanna and Z. Zylicz (Eds.). Cancer Pain. London, 2013. DOI 10.1007/978-0-85729-230-19.
Many cancer patients suffer moderate to severe pain, but owing to a focus on the prevention of abuse of and dependence on drugs, medical access to opioid analgesics has been neglected. Today, opioid analgesics are not readily available for medical use in many parts of the world. The World Health Organization (WHO) estimates that 5.5 billion people (83 % of the world’s population) live in countries with low to non-existent access to controlled medicines and have inadequate access to treatment for moderate to severe pain. Although some have been advocating for improved pain management for several decades, only recently has the inadequate access to and availability of opioid analgesics become an internationally recognised problem.
Measuring opioid analgesic consumption is possible using data from the International Narcotics Control Board. This requires aggregation of the various opioid analgesics expressed in "mg morphine equivalents". For determining the level of consumption that will be adequate in a country, its per capita consumption can be compared with the consumption level in most developed countries by calculating the Adequacy of Consumption Measure (ACM). A correction of the need for opioid analgesics depending on the morbidity level in a country is possible by using HIV, cancer, and injuries as a proxy, but this has its limitations owing to the unreliability of health statistics in some countries. Independent of the method, all methods show that there is a huge disparity between countries: the difference between the countries with the highest and lowest ACM in 2006 was 40,000 folds.