WHO publishes new report on access to morphine

Kampala, Uganda | THE INDEPENDENT | The World Health Organization (WHO) has published a new report on access to morphine for medical use. The report describes how the global distribution of morphine, as a vital pain medicine, is unequal and does not fulfill the medical need.

The report, titled “Left Behind in Pain” released on Friday highlights the problems in access to this essential medicine and offers actions to improve safe access through a balanced policy.

Despite morphine being an effective and relatively low-cost medicine for relieving strong pain, listed since 1977 in the first edition of the WHO Model List of Essential Medicines, the disparity in access across countries is stark with a five to sixty-three -fold difference in the estimated median consumption of morphine between high-income countries and lower-income countries.

Consumption pattern varies significantly across countries of similar wealth; it does not correspond to medical need, as indicated by the estimated number of days people are in pain or suffer from severe shortness of breath for people with a terminal illness.

This data echoes that of the 2018 Lancet Commission which described the lack of access to pain relief medication as ‘one of the most heinous, hidden inequities in global health’ with the richest 10% of countries possessing 90% of distributed morphine-equivalent opioids.

“Leaving people in pain when effective medicines are available for pain management, especially in the context of end-of-life care, should be a cause of serious concern for policy-makers,” says Dr Yukiko Nakatani, WHO Assistant Director-General for Medicines and Health Products in a statement shared along with the report. “We must urgently advocate for safe and timely access to morphine for those in medical need through balanced policy, everywhere.”

The report points out the reasons for the disparity as being related to good governance, reliable/efficient procurement and supply processes, resource availability, and capacity-building activities, along with barriers related to overly restrictive legislation and policies, inadequate service provision, and misinformed attitudes and perceptions.

For this report, a survey was conducted among respondents in 105 WHO member countries where the irregular supply of morphine and other strong opioids at health facilities due to limited financing was commonly noted as a barrier in low- and middle-income countries compared to high-income countries.

More than a third of respondents across all regions also noted barriers arising from legislative and regulatory factors while recognizing the importance of a legislative and regulatory framework in achieving safe access.

However, the report presents a set of areas for action that aim to improve safe access to morphine. These include implementing small-scale regional or state-wide programs on improving access to morphine for medical use and streamlining procurement and supply processes to address any inefficiency, improving resourcing such as stable funding, and enhancing competent skill sets of the health workforce, and raising awareness about both the benefits and potential harms of opioid use.

The success of these actions experts at the WHO say will hinge on collaboration and cooperation among all stakeholders at national, regional, and global levels.

******

URN