This page describes the analysis of some basic data to describe the landscape of access to pain relief.
Morphine equivalent is a metric to standardize doses of opioids by potency and allow combination and comparison of different medicinal opioids. It is calculated as
This equation is taken from the ratios of the defined daily dose (oral dosing for all except fentanyl, which is trans-dermal) as described by the WHO Collaborating Centre for Drug Statistics Methodology (1).
Because of methadone's widespread use as opioid substitution therapy, non-methadone morphine equivalent is also used in some instances and is calculated as
Non-meth Mor Eq=(1*morphine)+(83.3*fentanyl)+(5*hydromorphone)+(1.33*oxycodone)+(0.25*pethidine)
Opioid consumption data are taken a dataset provided by the International Narcotics Control Board (INCB) with the release of their annual report for narcotics consumption (2). For each drug, the average of non-missing consumption data over the last 3 years (2008-2010) is used. Data also published on the INCB website (3)(4)(5).
DEATHS IN PAIN
It is assumed that 80% of cancer deaths and 50% of HIV deaths require morphine and that the morphine required for each death in pain is 67.5 mg/day for 91.5 days (6)
The number of deaths due to cancer and HIV is estimated by applying the mortality rates from the 2008 update of the WHO 2004 cause of death dataset (7) to national population estimates for 2010 from the WHO (8).
UNTREATED DEATHS IN PAIN
It is assumed that all of the morphine is used for deaths in pain due to cancer or HIV. The number of untreated deaths in pain is calculated by subtracting the number of deaths in pain that could be treated with the total morphine equivalent in the country from the total number of deaths in pain.
1. WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index [Internet]. 2011. Available from:
2. International Narcotics Control Board. Consumption of principal narcotic drugs (1991-2010). 2012.
3. United Nations International Narcotics Control Board. Narcotic Drugs: Estimated World Requirements for
2012-Statistics for 2010 [E/INCB/2011/1] [Internet]. 2011. Available from: http://www.incb.org/incb/en
4. United Nations International Narcotics Control Board. Narcotic Drugs: Estimated World Requirements for
2011-Statistics for 2009 [E/INCB/2010/2] [Internet]. [cited 2011 Oct 28]. Available from: http://www.incb.org
5. United Nations International Narcotics Control Board. Narcotic Drugs: Estimated World Requirements for 2010;
Statistics for 2008 (E/INCB/2009/2) [Internet]. 2009. Available from: http://www.incb.org/pdf/technical-
6. Foley KM, Wagner JL, Joranson DE, Gelband H. Pain Control for People with Cancer and AIDS. Disease Control
Priorities in Developing Countries. 2nd ed. New York: Oxford University Press; 2006. p. 981–94.
7. World Health Organization. The global burden of disease: 2004 update [Internet]. 2008 [cited 2010 Nov 10].
Available from: http://www.who.int/evidence/bod
8. Global Health Observatory estimates of population, 2010 [Internet]. 2010. Available from: http://apps.who.int