Use of and barriers to access to opioid analgesics: A worldwide, regional, and national study

February 2016
Berterame, S., Erthal, J., Thomas, J., Fellner, S., Vosse, B., Clare, P., Hao, W., Johnson, D.T., Mohar, A., Pavadia, J., Samak, A.K.E., Sipp, W., Sumyai, V., Suryawati, S., Toufiq, J., Yans, R., Mattick, R.P. (2016). Use of and barriers to access to opioid analgesics: A worldwide, regional, and national study. The Lancet, Advance online publication,

Use of common opioid painkillers such as codeine, morphine and oxycodone has more than quadrupled in Australia over the past decade and doubled worldwide over the same period a report published on 3 February 2016 by the International Narcotics Control Board (INCB) reveals. Yet at the same time the authors warn that the majority of countries, particularly those in developing and poorer regions have little or no access to basic pain medication and there has been little change over the decade. 

A research team from the INCB including Professor Richard Mattick of the National Drug and Alcohol Research Centre at UNSW Australia calculated the daily use of opioid analgesics for countries and regions globally over the period 2001 to 2013, compared the data against the prevalence of health conditions requiring pain relief and surveyed 214 countries about any impediments to availability of the medications. 

The authors found that the bulk of the increase occurred in high income western countries and regions including North America, Western and Central Europe and Australia and New Zealand, which together accounted for more than 95 per cent of global opioid use. By contrast, the majority of poorer and less developed nations had little or no access to opioid pain relief and there had been no significant increase in use in these regions over the period. Over five and a half billion people are estimated to have little or no access to essential pain relief. 

Professor Mattick, senior author on the paper said that the correct level of opioid use was unclear. 

“The ageing populations and greater care for chronic non-cancer pain are likely drivers of increased use in high-income countries,” he said.  “However, the lack of availability of these medications in low-income countries for the management of cancer pain is a terrible situation causing massive suffering,” said Professor Mattick.