The World Health Organization (WHO) has published a new report on access to morphine for medical use, which describes how the global distribution of morphine, as a vital pain medicine, is unequal and does not fulfil the medical need. The report, titled “Left behind in pain”, highlights the problems in access to this essential medicine and offers actions to improve safe access through balanced policy.

Despite morphine being an effective and relatively low-cost medicine for relieving strong pain, listed since 1977 in the first edition of the WHO Model list of Essential Medicines, the disparity in access across countries is stark. There is a 5- to 63-fold difference in the estimated median consumption of morphine between high-income countries and lower income countries.

Consumption pattern varies significantly across countries of similar wealth; it does not correspond to medical need, as indicated by the estimated number of days people are in pain or suffer with severe shortness of breath for people with a terminal illness.

This data echoes that of the 2018 Lancet Commission which described the lack of access to pain relief medication as ‘one of the most heinous, hidden inequities in global health’ with the richest 10% of countries possessing 90% of distributed morphine-equivalent opioids.

“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,” says Dr Yukiko Nakatani, WHO Assistant Director-General for Medicines and Health Products.