Is opioid over-regulation hurting cancer patients?

Few dispute the role of opioids in the treatment of pain in patients with advanced cancer. However, while there has been much energy devoted to improving cancer pain management, most of the world’s population still lack access to appropriate medications for cancer pain relief. In 2006, 17% of the world’s population, primarily those in some industrialized countries, consumed 80% of the world’s opioids [1]. The WHO’s Access to Controlled Medicines Program documented that 5.5 billion people (83% of the world’s population) live in countries with low to nonexistent access to opioids. The regional differences in opioid consumption throughout the world are shown in Figure 1. In 2010, opioid consumption was calculated by the International Narcotics Control Board (INCB) to be ‘inadequate’ in 50 countries, and ‘very inadequate’ in more than 100 countries [2]. The Global Task Force for Cancer Control [3] identified the discrepancy in opioid usage between the highest ten consuming countries to be 50,000-times greater than that used by the ten lowest consuming countries. This opioid use discrepancy and, therefore discrepancy in pain and physical suffering, was associated with all cancers, including those for which neither effective cancer treatment nor prevention was possible. The 50,000-times difference was compared with the 4–20-fold differences seen in cancer screening and pediatric cancer control interventions between the highest and lowest ranking countries.

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