Advertisement

Hot Topic: Global Trends in the Use of Opioid Analgesics

  • Juliana ErthalEmail author
  • Stefano Berterame
  • Philip Clare
  • Richard P. Mattick
Opioids (D Fiellin and J Donroe, Section Editors)
  • 20 Downloads
Part of the following topical collections:
  1. Topical Collection on Opioids

Abstract

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.

Recent Findings

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.

Summary

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.

Keywords

Opioid Analgesia Pain management Palliative care Morphine Fentanyl 

Notes

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.

Disclaimer

The views expressed herein are those of the authors and do not necessarily reflect the views of the United Nations.

Supplementary material

40429_2019_234_MOESM1_ESM.docx (19 kb)
Supplementary Figure S1 Trends from 1995 to 2015 in use of five most common opioid analgesics—fentanyl, hydrocodone, oxycodone, morphine, and hydromorphone, adjusted for country-level GDP per capita and HDI category, and taking into account inefficiency in fentanyl patches (DOCX 18 kb)

References

  1. 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
  2. 2.
    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.CrossRefGoogle Scholar
  3. 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
  4. 4.
    Knaul FM, Farmer PE, Krakauer EL, de Lima L, Bhadelia A, Jiang Kwete X, et al. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the lancet commission report. Lancet. 2018;391:1391–454.CrossRefGoogle Scholar
  5. 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
  6. 6.
    Gisev N, Larance B, Cama E, Nielsen S, Roxburgh A, Bruno R, et al. A nationwide study of the extent and factors associated with fentanyl use in Australia. Res Soc Adm Pharm. 2018 Mar;14(3):303–8.CrossRefGoogle Scholar
  7. 7.
    De Lima L, Pastrana T, Radbruch L, Wenk R. Cross-sectional pilot study to monitor the availability, dispensed prices, and affordability of opioids around the globe. J Pain Symptom Manag. 2014;48(4):649–59.CrossRefGoogle Scholar
  8. 8.
    McPherson ML. Demystifying opioid conversion calculations. Bethesda: ASHP; 2010.Google Scholar
  9. 9.
    International Narcotics Control Board. Narcotic drugs 2008: estimated world requirements for 2009—statistics for 2007. New York: United Nations; 2008.Google Scholar
  10. 10.
    International Narcotics Control Board. Narcotic drugs 2016: estimated world requirements for 2017—statistics for 2015. New York: United Nations; 2016.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Juliana Erthal
    • 1
    • 2
    Email author
  • Stefano Berterame
    • 1
  • Philip Clare
    • 2
  • Richard P. Mattick
    • 2
    • 3
  1. 1.Secretariat of the International Narcotics Control Board, Vienna International CentreViennaAustria
  2. 2.National Drug and Alcohol Research Centre, Faculty of MedicineUniversity of New South WalesSydneyAustralia
  3. 3.International Narcotics Control Board, Vienna International CentreViennaAustria

Personalised recommendations