Calculating worldwide needs for morphine for pain in advanced cancer and proportions feasibly met by country estimates of requirements and consumption. Retrospective, time-series analysis (1997–2017)

Clark, J; Crowther, L; Johnson, MJ; Ramsenthaler, C; Currow, DC

Calculating worldwide needs for morphine for pain in advanced cancer and proportions feasibly met by country estimates of requirements and consumption. Retrospective, time-series analysis (1997–2017)

Clark, J Crowther, L Johnson, MJ Ramsenthaler, C Currow, DC

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Publisher:: Public Library of Science (PLoS)
Publication Type:: Journal Article
Citation:: PLOS Global Public Health, 2, (7), pp. e0000533

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Field	Value	Language
dc.contributor.author	Clark, J
dc.contributor.author	Crowther, L
dc.contributor.author	Johnson, MJ
dc.contributor.author	Ramsenthaler, C
dc.contributor.author	Currow, DC
dc.contributor.editor	Mehra, N
dc.date.accessioned	2023-02-15T05:31:46Z
dc.date.available	2023-02-15T05:31:46Z
dc.identifier.citation	PLOS Global Public Health, 2, (7), pp. e0000533
dc.identifier.issn	2767-3375
dc.identifier.issn	2767-3375
dc.identifier.uri	http://hdl.handle.net/10453/166149
dc.description.abstract	<jats:p>Lack of access to therapeutic opioids continuing causes global health inequalities. Access to morphine for symptom control is regulated under the terms of the Single Convention on Narcotics, countries must submit annual morphine requirement estimates and report consumption to the International Narcotics Control Board (INCB). INCB indicates access to morphine is increasing, however, estimated needs are unreported so changing proportions of needs feasibly met by requirements and consumption are unknown. Retrospective time series-analysis taking cross-sections every five years of gaps between <jats:italic>calculated needs</jats:italic> for morphine for people who die from cancer and <jats:italic>total treatable</jats:italic> using <jats:italic>estimates of requirements</jats:italic> and <jats:italic>consumption</jats:italic> (1997, 2002, 2007, 2012, 2017). We <jats:italic>calculated need</jats:italic> using INCB-recommended methods (80% of people who die from cancer require 67.5mg of morphine daily for 90 days (6.075g)) for countries reporting <jats:italic>estimates</jats:italic> and <jats:italic>consumption</jats:italic> using Global Burden of Disease cancer deaths by country. Gaps between <jats:italic>calculated need</jats:italic> and <jats:italic>total treatable</jats:italic> population using <jats:italic>estimates</jats:italic> and <jats:italic>consumption</jats:italic> were calculated. We report proportions of need feasibly met by <jats:italic>estimates</jats:italic> and <jats:italic>consumption</jats:italic> for included countries, by World Bank Income group. Global availability of morphine increased, from <jats:italic>estimates</jats:italic> sufficient to treat 86% of <jats:italic>calculated needs</jats:italic> in 1997, to 701% in 2017. However, proportion of countries <jats:italic>estimating requirement</jats:italic>s feasibly meeting >100% of <jats:italic>calculated needs</jats:italic> rose only from 16% to 30%. Almost all Low-and-Middle-Income Countries submitted inadequate <jats:italic>estimates</jats:italic> with little change in 20 years. <jats:italic>Consumption</jats:italic> was lower than <jats:italic>calculated needs</jats:italic> at all time-points. Very few countries reported <jats:italic>consumption</jats:italic> greater than their <jats:italic>estimate of requirement</jats:italic>. Most countries submitted morphine <jats:italic>estimates</jats:italic> insufficient to meet analgesic needs of people who died from cancer. <jats:italic>Estimates of requirements</jats:italic> contextualise future <jats:italic>Consumption</jats:italic>, and increases in adequacy of <jats:italic>estimates</jats:italic> and <jats:italic>consumption</jats:italic> were minimal over 20 years. Annual publication of <jats:italic>calculated morphine needs</jats:italic> alongside <jats:italic>estimates</jats:italic> and <jats:italic>consumption</jats:italic> may be a key step to drive countries’ accountabilities.</jats:p>
dc.language	en
dc.publisher	Public Library of Science (PLoS)
dc.relation.ispartof	PLOS Global Public Health
dc.relation.isbasedon	10.1371/journal.pgph.0000533
dc.rights	info:eu-repo/semantics/openAccess
dc.title	Calculating worldwide needs for morphine for pain in advanced cancer and proportions feasibly met by country estimates of requirements and consumption. Retrospective, time-series analysis (1997–2017)
dc.type	Journal Article
utslib.citation.volume	2
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	open_access	*
dc.date.updated	2023-02-15T05:31:45Z
pubs.issue	7
pubs.publication-status	Published online
pubs.volume	2
utslib.citation.issue	7

Abstract:

Lack of access to therapeutic opioids continuing causes global health inequalities. Access to morphine for symptom control is regulated under the terms of the Single Convention on Narcotics, countries must submit annual morphine requirement estimates and report consumption to the International Narcotics Control Board (INCB). INCB indicates access to morphine is increasing, however, estimated needs are unreported so changing proportions of needs feasibly met by requirements and consumption are unknown. Retrospective time series-analysis taking cross-sections every five years of gaps between calculated needs for morphine for people who die from cancer and total treatable using estimates of requirements and consumption (1997, 2002, 2007, 2012, 2017). We calculated need using INCB-recommended methods (80% of people who die from cancer require 67.5mg of morphine daily for 90 days (6.075g)) for countries reporting estimates and consumption using Global Burden of Disease cancer deaths by country. Gaps between calculated need and total treatable population using estimates and consumption were calculated. We report proportions of need feasibly met by estimates and consumption for included countries, by World Bank Income group. Global availability of morphine increased, from estimates sufficient to treat 86% of calculated needs in 1997, to 701% in 2017. However, proportion of countries estimating requirements feasibly meeting >100% of calculated needs rose only from 16% to 30%. Almost all Low-and-Middle-Income Countries submitted inadequate estimates with little change in 20 years. Consumption was lower than calculated needs at all time-points. Very few countries reported consumption greater than their estimate of requirement. Most countries submitted morphine estimates insufficient to meet analgesic needs of people who died from cancer. Estimates of requirements contextualise future Consumption, and increases in adequacy of estimates and consumption were minimal over 20 years. Annual publication of calculated morphine needs alongside estimates and consumption may be a key step to drive countries’ accountabilities.

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http://hdl.handle.net/10453/166149