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Opioid analgesics, including morphine, are considered essential medicines by the World Health Organization and are recommended for the treatment of moderate to severe pain.

Opioids are also on almost all national essential medicines lists, but access to them is severely limited in most low- and middle-income countries, where 85% of the world’s population consumes just 7% of the medicinal opioids. There is no more striking example of the global disparity in access to health care than pain relief in cancer.

 

There is no more striking example of the global disparity in access to health care than pain relief in cancer.

Sub-Saharan Africa & South Asia are home to 73% of the world’s untreated deaths in pain.

Percentage of deaths that are not treated for pain by region, 2011

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Map showing that Sub-Saharan Africa & South Asia are home to 73% of the world’s untreated deaths in pain in 2011

Approximately 80% of people with advanced cancer experience moderate to severe pain. Untreated pain that grows worse each day is a consistent feature of cancer care in most resource-limited settings.

Although morphine, the most effective treatment for severe pain, is safe, effective, plentiful, inexpensive, and easy to use, legal and regulatory restrictions, cultural misperceptions about pain, inadequate training of healthcare providers, a poorly functioning market, generally weak health systems, and concern about diversion, addiction, and abuse create a web of barriers that force millions of people to live and die with treatable pain.

The provision of pain relief is the mandate of national governments, and several governments are taking steps to improve access to pain relief. In particular, Nigeria, which is home to approximately 20% of the population of Sub-Saharan Africa, has embarked on a new initiative to improve access to oral morphine. The government of Uganda now makes oral morphine available to patients at no cost, and the government of Kenya has committed to expanding availability of pain relief through the public sector.

Pain treatment coverage rates have been increasing over the last four years, with the greatest gains being made in middle-income countries.

Percentage of treated deaths in pain by income level, 2008–2011

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Chart for pain treatment coverage rates globally and in high-, middle-, and low-income countries

“There are a lot of people suffering around the world [although] we have the knowledge, and the experience, and the medications available to stop it.”

Mary Callaway, Open Society Foundations