The World Health Organization (WHO) has released a new study on medical morphine access, which outlines how the global distribution of morphine, as a critical pain treatment, is uneven and does not meet medical needs. The paper, titled “Left Behind in Pain,” addresses the issues with access to this critical prescription and proposes solutions to increase safe access through balanced policy.
Despite the fact that morphine is an effective and relatively low-cost drug for alleviating severe pain, and has been on the first edition of the WHO Model List of Essential Medicines since 1977, availability varies greatly among nations. The estimated median intake of morphine differs by a factor of 5 to 63 between high-income and low-income nations.
The consumption pattern differs dramatically between nations of similar affluence; it does not correlate to medical necessity, as evidenced by the expected number of days patients with terminal illnesses are in agony or suffer from acute shortness of breath.
This data is consistent with the findings of the 2018 Lancet Commission, which labeled the lack of access to pain treatment medications as “one of the most heinous, hidden inequities in global health,” with the richest 10% of nations holding 90% of the distributed morphine-equivalent opioids.
“Leaving people in pain when effective medicines for pain management are available, particularly in the context of end-of-life care,” says Dr Yukiko Nakatani, WHO Assistant Director-General for medications and Health Products. “We must urgently advocate for safe and timely access to morphine for those in medical need through balanced policy, everywhere.”
Causes of the discrepancy
Many interacting factors influence access to morphine for medical use, including enablers such as good governance, dependable/efficient procurement and supply processes, resource availability, and capacity-building activities, as well as barriers such as overly restrictive legislation and policies, inadequate service provision, and misinformed attitudes and perception.
Given varied national circumstances, facilitators, impediments, and action objectives change; a stakeholder survey provided in this research, which included respondents from 105 WHO Member States, verifies this variance. In low- and middle-income nations, for example, erratic supply of morphine and other powerful opioids at health institutions was frequently cited as a barrier compared to high-income ones. More over a third of respondents in all areas identified legislative and regulatory impediments, acknowledging the need of a legal and regulatory framework in providing safe access. Unreasonably stringent restrictions may limit patient access by impeding supply flow or making prescription and dispensing difficult for health-care personnel.
It is vital to stress that worries regarding opioids’ possible adverse consequences, such as their ability to lead to opioid use disorder, are real. As a result, a degree of caution regarding the possible downsides of opioid use (e.g., usage in chronic non-cancer pain) is vital for public health, as long as it is well-informed and appropriate to risks. Such reservations should not be allowed to overshadow the benefits of opioid usage when clinically recommended and used properly by experienced experts.
Possibilities for action
The study includes a supplemental list of action items aimed at improving safe access to morphine. These include implementing small-scale regional or state-wide programs to improve access to morphine for medical use in conjunction with a package of essential palliative care services and products formulated in accordance with the WHO Model List of Essential Medicines and the WHO Essential Package of Palliative Care. boosting governance, optimizing procurement and supply systems to address inefficiencies, boosting resources such as secure financing, enhancing competent skill sets of the health staff, and raising knowledge about both the benefits and possible hazards of opioid use are also among them. Collaboration and coordination among all stakeholders at the national, regional, and global levels will be critical to the success of these initiatives.
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