Bringing severe pain to an end

90% of the morphine for pain relief is consumed by 10% of the world’s richest countries. Asia’s morphine per capita consumption is 36 times less than the global average. The roots of the “access abyss” can be historically traced through the commodification of substances that were traditionally used as medicine.

Current policies – largely determined and imposed by the Global North, and influenced by the US narrative – are centred around licencing, prescription and control, disproportionately impacting the very countries that grow and manufacture the raw material. Western corporate capture continues to dictate and shape access, manifested in essential medicines lists and reimbursable insurance packages.

The UN Drug Conventions place on all member states the dual obligation of two core imperatives – to prevent the non-medical use of controlled substances, and equally, to ensure adequate availability of controlled substances for medical and scientific purposes. Historical misalignment between these two core imperatives has produced two opioid crises – one of access and “the global pandemic of untreated pain,” and the other a more regionally defined epidemic of opioid use disorder and fatal overdose.

Excessive prescription opioids in some countries shouldn’t blind policy makers to the pain crisis in other countries. The singular focus on inappropriate use is not adequately evened out by the available evidence of successful achievement of balance, which should be models.

Let us focus on not only improved access, but safe access to opioids. On well-calibrated, compassionate and smart regulatory systems, and fit-for-purpose supply chains for controlled medicines, while simultaneously providing the guardrails of training and evidence-based information about the safe use of opioids for pain relief.