Availability of opioids: access, not excess

Authors

Dr. Jallal Toufiq (⚑ Morocco) 1

1. University Mohamed V

Abstract

Governments have a dual obligation to ensure adequate availability of narcotic drugs for medical and scientific purposes and prevent diversion and abuse (Preamble, Single Convention on Narcotic Drugs, 1961). Despite a global increase in the availability of opioid analgesics, disparity and imbalance in access to them remain evident. The increase in the use of expensive synthetic opioids has not been matched by an increase in the use of affordable morphine. Most of the morphine available is not utilized for palliative care, especially in low- and middle-income countries that cannot afford expensive synthetic opioids. Impediments reported by Governments indicate that compliance with the requirements of the conventions is perceived to be less and less of a problem. Factors such as fear of diversion, fear of addiction, fear of prosecution and cultural attitudes remain relatively stable or decreased in importance.

The lack of training and the awareness of health professionals with respect to the prescribing and dispensing of opioid analgesics are the major issues. Many factors contribute to over-prescription of opioids leading to misuse and abuse. In some countries, primary care physicians and GPs have poor training in opioid prescription. 24% of competent national authorities mentioned lack of financial resources to procure medicines containing controlled substances. Training in pain and palliative care is rarely part of the educational curricula of medical and nursing schools and it is not always mandatory.