Analyzing and Benchmarking Global Consumption Statistics for Opioid Analgesics 2015: Inequality Continues to Increase

Abstract

Many countries around the world have a very low per capita consumption of opioid analgesics, which is probably related to absence or inadequate management of moderate and severe pain for large parts of their populations. We conducted a longitudinal observational study with opioid analgesic consumption data for all countries from 2000–2015, to assess 2015 per capita consumption data for strong opioid analgesics and to investigate the hypothesis that inequality decreased over the years 2000–2015. We based our study on the official statistics kept by the International Narcotics Control Board, built on data submitted by governments annually. Adequate consumption was defined as the average 2015 opioid analgesic consumption of the 20 most-developed countries, or above. In addition, we defined categories of moderate, low, very low and extremely low consumption, each category differing 0.5 on a logarithmic scale. Consumption was expressed as the AOC Index. The direction of inequality in consumption between different countries’ development levels through the years 2000–2015 was assessed using a mixed effects model. We found that the average consumption of the 20 most-developed countries was 256 ± 208 mg per capita (range 5.9–778) in 2015. In all, 119 countries did not have a moderate or adequate consumption of opioid analgesics. Inequality of adequacy of consumption between low- and highly-developed countries increased from 2000 to 2015. The world needs 1867 tonnes ME for treating pain with opioids analgesics at an adequate level (actual use: 365 tonnes or 19.5% of the global need). We concluded that in 2015, almost 6.5 billion people lived in countries where opioid analgesic consumption was low, very low, or extremely low.

Keywords:

• Analgesics
• Opioids
• Pain Management
• Health Policy
• Needs Assessment

Acknowledgments

The authors acknowledge the International Narcotics Control Board for making data available. W.S. designed the study, collected the data, analyzed and interpreted the data, drafted the manuscript and approved the final manuscript as submitted. A.-E.C. has contributed to the design of the work, analyzed the data, contributed drafting the manuscript and approved the final manuscript as submitted. A.E.O. and A.M.D. contributed to the design of the work, critically reviewed and revised the manuscript and approved the final manuscript as submitted.

Disclosure statement

W.S. is a member of the Editorial Board of the Journal of Pain and Palliative Care Management. He provides consulting services as an independent consultant on regulation of and policies related to psychoactive substances. This included work for CannNext, DrugScience, Grünenthal, and Jazz Pharmaceuticals. He received honoraria for lecturing from Mundipharma and received travel support from the German Pain Federation and Grünenthal. A.E.O. and A.-E.C. declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article. A.M.D. has received unrestricted research grants from Mundipharma and Grünenthal.

Table 1e. AOC Index 2015 for countries in the WHO South-East Asian Region (SEARO), with global ranking in the AOC Index.

Table 1f. AOC Index 2015 for countries and territories in the WHO Western Pacific Region (WPRO), with global ranking in the AOC Index.

Table 1g. AOC Index 2015 for other countries and territories, with global ranking in the AOC Index.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.