Millions suffer preventable pain because of morphine disparity, WHO says

Morphine has long been a front-line treatment for pain, easing end-of-life transitions in palliative care and helping people undergoing medical emergencies, surgeries and chronic conditions. But the vital drug is unequally distributed worldwide, World Health Organization officials say in a new report.

“Millions of people continue to suffer preventable pain,” they write – calling attention to what they say is a medical and moral emergency.

The document is a report card on morphine availability and use worldwide, and reveals deep disparities in who can access the drug, an opium-derived medication available in pill and shot form for medical use.

It’s one of the oldest and least expensive opioids, but nonetheless is used more in higher-income countries such as the United States, which utilizes nearly 80% of the supply for the Americas region.

In contrast, lower-income countries face severe shortages because of irregular supply, local policies, lack of providers and stigma. Despite having similar medical needs, high-income countries consumed an estimated 125.9 doses per million people per day in 2021, compared with only two doses per million people per day in low-income countries.

To even out availability, the authors recommend establishing affordable pricing policies worldwide, creating distribution hubs and expanding access for people with conditions other than cancer and HIV.

Countries must also contend with the potential harms of morphine use, including substance misuse and illicit trade, officials write. Tight opioid regulations worldwide can make it hard to obtain the drug in medical settings, and negative attitudes persist among health-care workers who fear prescribing morphine will cause long-term dependence in patients.

The authors cite one literature review that estimated 4.7% of those who use opioids to manage pain will go on to develop a future use disorder. But that’s not a reason to let people suffer rather than prescribe a safe, inexpensive and well-known pain medication, they conclude.

“Leaving people in pain when effective medicines are available for pain management, especially in the context of end-of-life care, should be a cause of serious concern for policy-makers,” Yukiko Nakatani, WHO assistant director general for medicines and health products, said in a news release.