A recently published report by the World Health Organization (WHO) titled “Left behind in pain: extent and causes of global variations in access to morphine for medical use and actions to improve safe access” discusses significant disparities in the consumption of narcotic analgesics between countries. The report also presents the results of expert surveys, particularly regarding measures that could be crucial for ensuring patient access to narcotic analgesics.
According to estimates, over 95% of all opioids (in morphine-equivalent doses) are distributed in high-income countries, while only 0.03% are found in low-income countries. Furthermore, even if morphine is available in these countries, patients with medical opioid needs typically have access to an average of only 10 mg of morphine-equivalent opioids per year (Knaul F.M. et al., 2018), which is less than half a day’s standard starting dose for adults. Many individuals lack access altogether.
Turkey, Australia, France, and China were the main cultivators of opium poppy (Papaver somniferum) for pharmaceutical production in 2021. From 2015 to 2020, 80% of the global sales of commercially available morphine products in raw form were attributed to 10 pharmaceutical companies (IQVIA, 2022).
In 2021, a total of 33,115 kg of morphine was distributed for medical (and scientific) purposes worldwide. The distribution of morphine for medical consumption was highly uneven, with over 80% allocated to countries in the WHO American and European regions, particularly those classified as high-income by the World Bank. For example, in the American region, the distribution of morphine for consumption was concentrated in the United States (76.7%) and Canada (12.6%).
The consumption of morphine per day and per million population in high-income countries in 2021 amounted to 125.9, 24.9, 6.7, and 2.0 defined daily doses (DDD) for countries with high, above-average, below-average, and low-income levels, respectively. The corresponding figures