Millions die suffering amid global opioid gap, report says

Nearly 26 million people around the world die each year with serious suffering in part because of a huge gap in pain relief: The U.S. may be awash in opioid painkillers, but they’re rare or unavailable in dozens of poor countries, says a new report.

The challenge is to improve palliative care in low-income countries while avoiding mistakes that led to the U.S. addiction crisis.

The report to be published Friday in The Lancet says one key is using off-patent morphine that costs pennies a dose—not profitable for drug companies that push pricier, more powerful opioids in rich countries, but critical to easing a health emergency.

In some places, even children dying of cancer or children in treatment for cancer can’t get pain relief, said University of Miami professor Felicia Knaul. She co- chaired a Lancet-appointed international commission that spent three years studying the disparity and what she calls “the moral obligation” to help.

“This report finally gives voice to the suffering and a roadmap to governments,” Knaul said.

Of the few hundred tons of morphine and equivalent opioids distributed worldwide, less than four percent goes to low- and middle-income countries, the researchers reported.

How much is needed? The Lancet Commission provided the first global estimates of the need for palliative care, defined as “serious healthrelated suffering” from certain life-threatening conditions, including cancer, HIV and trauma.

Some 2.5 million children are among the annual count of nearly 26 million who die without adequate relief, the team calculated.

Another 35.5 million people a year have serious pain and suffering from those conditions but aren’t dying, and most live in low- or middle- income countries.

The world’s poorest countries have access to enough morphine to meet less than two percent of their palliative care needs, the report found. India fares little better, at four percent; China meets 16 percent of its need, and Mexico 36 percent.

The 2010 earthquake in Haiti highlighted the scarcity, as doctors lacked opioids for people who were severely injured or needed surgery, the commission noted.

Beyond painkillers, the panel urged health systems to make available an “essential package” of palliative care services that also includes medications to ease breathing problems, muscle spasms, complications of heart or liver failure, and depression and psychological suffering. The list also includes practical equipment like pressure sorereducing mattresses, adult diapers—and a lock box for any needed morphine.