Low- and middle-income countries

In this step, Dr Fausto Morell-Ducos, Consultant in Anaesthesia and Pain Medicine at University College London Hospitals, discusses opioid prescription patterns in low- and middle-income countries (LMICs).

The WHO estimates that 5.5 billion people do not have access to treatments for moderate-to-severe pain, while more than 90% of the world’s opioids are consumed by less than 20% of the world’s population [1]. This disparity in availability of opioids goes hand in hand with the inequality of access to safe surgery, whereby out of the nearly 232 million major surgeries which take place worldwide every year, only 3.5% occur in LMICs, in spite of the fact they contain more than 85% of the world’s population.

Distributed opioid morphine-equivalent (morphine in mg/patient in need of palliative care, average 2010-13), and estimated percentage of need that is met for the health conditions most associated with serious health-related suffering. From Knaul et al (2018) [2].

The lack of access to analgesic treatments, in particular morphine, has been attributed to a number of factors including low prioritisation of pain relief, patient and staff expectations and attitudes, lack of staff training and lack of access [1].

Your turn now

Use the comments section below to share your thoughts and experiences. Watch the short BBC News video clip below. Consider what the consequences of limited opioid use may be in surgical patients. Where do you think the righ balance lies between restricting opioid use and allowing patients to benefit from analgesia?

Please do not share any details that could be patient-identifiable. You can ‘like’ and comment on other learners’ comments, as well as ‘follow’ other learners so you don’t miss their comments.

References

_{1. Morriss WW, Roques CJ. Pain management in low- and middle-income countries. BJA Ed 2018;18:265-70.}

_{2. Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete XJ, et al. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report. 391(10128):1391-1454.}

_{3. The negative impact of drug control on public health: the global crisis of avoidable pain. The Global Commission on Drug Policy, Geneva (2015).}