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[Contents]

Section III

Medical Need for Opioid Analgesics

In 1986, the participants of the WHO Meeting on the Comprehensive Management of Cancer Pain (6) declared that:

"In patients with severe pain, morphine -- a strong opioid -- is the drug of choice" (p. 18).

In 1986, the WHO announced to the world that most, if not all, cancer pain could be relieved if currently available medical knowledge was implemented (6). Cancer pain can be relieved using a variety of drug and non-drug measures including opioid analgesics. However, morphine and opioids in the therapeutic group of morphine are considered essential when pain is moderate or severe (4, 5, 6). Health care professionals have been encouraged to use the proven three-step Analgesic Method (see Annex 1 for definition) that was developed by the WHO as an effective method to treat pain.

The WHO Expert Committee on Cancer Pain Relief and Active Supportive Care (4) stated in 1990 that:

"Freedom from pain should be seen as a right of every cancer patient and access to pain therapy as a measure of respect for this right" (p. 10).

Relief of severe cancer pain depends on the availability and use of opioids in the therapeutic group of morphine. These opioids do not have an "analgesic ceiling" (i.e., a pharmacological characteristic of a drug when an increased dose provides no additional analgesia). They can be administered safely in increasing doses until the pain is relieved, as long as side effects are tolerated (5). There is no standard treatment dose for these opioids. The appropriate dose to relieve the pain should be determined by the individual needs of the patient. ^[4]

Morphine and one or more other opioid pain medications, as well as other drugs used for pain and symptom management, must be available in adequate amounts, when patients need them, and in the places where patients are living (4).

In 1986, participants of the WHO Meeting on the Comprehensive Management of Cancer Pain (6) stated:

"Of 22 drugs commonly used for cancer pain relief, eight are covered by the 1961 Single Convention on Narcotic Drugs and one by the 1971 Convention on Psychotropic Substances..." (p. 27).

The WHO Expert Committee on Essential Drugs (7) has for many years designated morphine, codeine and other opioids as "essential drugs," defined as:

"those that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in the appropriate dosage forms..." (p. 2).

The total global consumption of morphine increased significantly as some national governments and health professionals adopted the WHO Analgesic Method for cancer pain relief. However, the majority of the increasing consumption of morphine occurred in a small number of developed countries that represent a small part of the world’s population (3). More recently, morphine consumption has begun to increase in other countries, including in a number of developing countries. The statistical data from the INCB for the period from 1990 to 1998 show that substantial increases have occurred in both developed and developing countries, while consumption in other countries has remained stable or even decreased. Most countries use very little morphine.

Annex 4 presents data on the consumption of a wider range of opioids stated in the form of defined daily dose (see Annex 1 for definition) per million, and expressed as a five-year average. Annex 4 allows for the comparison of the consumption of a number of opioids within and between countries. In many countries, consumption remains extremely low in comparison to the medical need, and many national governments have yet to address this important deficit (3).