Each year the Pain & Policy Studies Group (PPSG) receives from the International Narcotics Control Board (INCB) consumption data for 6 principal opioids used to treat moderate to severe pain:

These data represent the amounts of opioids distributed legally in a country for medical and scientific purposes to those healthcare institutions and programs that are licensed to dispense to patients, such as hospitals, nursing homes, pharmacies, hospices and palliative care programs. Consumption does not refer to the amounts dispensed to, or used by, patients, but rather to amounts distributed to the retail level.

The opioid consumption data are displayed in milligrams per capita (or per person), which is calculated by first converting the raw consumption data we receive from INCB from kilograms to milligrams and then dividing by the population of the country for a particular year. United Nations population data is used. This provides a population-based statistic that allows for comparisons between countries.

HOW DO THESE DATA DIFFER FROM THE DATA PUBLISHED IN THE INCB TECHNICAL REPORTS?

The INCB’s published technical reports do not provide values for quantities of opioids consumed that are less than 1kg.

monitor compliance of governments with the provisions of the Single Convention,
identify trade discrepancies between importing and exporting countries,
identify trends in the worldwide availability of opioids and other drugs for medical needs, and
monitor and maintain a global balance of supply and demand of opioids for medical and scientific needs.

Opioid consumption statistics also have several useful applications for advocates, policy-makers, or anyone interested in improving opioid availability. They can be used to:

identify whether a country has available opioids that can relieve moderate to severe pain,
learn whether the amounts indicate any substantial current consumption or progress over time, and
evaluate the outcome of efforts to improve opioid availability

WHAT ARE THE LIMITATIONS OF THESE DATA?

Consumption statistics provided in INCB reports have several limitations that should be considered when using them as an indicator of opioid availability for pain management:

some governments report late, do not report for a particular year or period, or make inaccurate reports, all of which result in incomplete or invalid information for that year. These deficiencies may be corrected in subsequent years as the INCB receives more complete data from the government;
consumption statistics do not distinguish between clinical uses for opioids, as in methadone for treatment of pain or dependence syndrome, or fentanyl for analgesia or anesthesia;
consumption statistics do not distinguish between programs that use opioid analgesics, such as hospitals and hospices;
consumption statistics do not indicate which products or dosage forms of an opioid are available within a country (i.e., whether an opioid is in oral, parenteral or transdermal form) and
consumption statistics are not a valid indicator of the quality of pain control in a country.

WHAT IS THE MORPHINE EQUIVALENCE METRIC?

Historically, the WHO has considered a country’s annual consumption of morphine to be an indicator of the extent that opioids are used to treat severe cancer pain and an index to evaluate improvements in pain management. However, over the past 20 years additional opioid analgesic medications and formulations, such as the fentanyl patch, hydromorphone, and sustained-release oxycodone, have been introduced in global and national markets and should be considered when studying opioid consumption in a country, region, and globally.

Using the INCB data it receives annually, and applying conversion factors from the WHO Collaborating Center for Drugs Statistics Methodology, PPSG developed a Morphine Equivalence (ME) metric, adjusted for population, for 6 principal opioids used to treat moderate to severe pain:

Fentanyl,
Hydromorphone,
Methadone,
Morphine,
Oxycodone, and
Pethidine.

The ME allows for equianalgesic comparisons between countries of the aggregate consumption of these principal opioids (total ME), thereby providing a more complete picture of a country’s capability to treat moderate to severe pain than is possible by analyzing morphine consumption alone. ME data are now provided on the global, regional and all country profile pages and will be annually updated as new data become available.

For more information about the morphine equivalence metric, visit:

“Opioid policy, availability, and access in developing and nonindustrialized countries” (linked to the Joranson Bonica chapter)- 2010 PPSG chapter in Bonica’s Management of Pain, 4th ed.

“Toward a more complete indicator of opioid consumption trends” (linked to a PDF of ME poster)
– a poster presented at the International Association of Pain & Chemical Dependency, New York, NY, 2007.

2008 Regional Opioid Consumption (mg/person) graphs and tables for each principal opioid
Regional Trend in Opioid Consumption in Morphine Equivalence (mg/person), 1980 – 2008 (Total ME compared to ME for each opioid) graph and table for each region

Regional office for Africa (AFRO)
Regional office for the Americas (AMRO)
Regional office for the Eastern Mediterranean (EMRO)
Regional office for Europe (EURO)
Regional office for South-East Asia (SEARO)
Regional office for the Western Pacific (WPRO)

The PPSG had assembled key information from INCB reports and UN publications for each country that reports consumption data to the INCB, expressed as a Country Profile. These profiles are updated as new information becomes available. We welcome comments, please send to: ppsg@uwcarbone.wisc.edu

Interactive opioid consumption maps:

This feature displays opioid consumption (mg/person) data on a global map, with each country color coded by level of consumption
Allows users to select which drug (codeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, pethidine and morphine equivalence) and year (1964 – 2008) to display
Provides an immediate visual image of the variation in consumption of opioids across the world

Interactive graphs for exploring opioid consumption trends: linked to the chart page w/ thumbnail?)

This feature allows users to explore relationships over time between opioid consumption and other country characteristics, such as Gross Domestic Product or Human Development Index.
There are several dimensions of these charts that users can make use of to explore these relationships:

X and Y Axes: Users can select indicators using the drop-down boxes along the chart axes.
Time: Click the play button to see how the relationship changes over time.
Country: Select a specific country in the list on the right to highlight its changes
Colors: Select a different indicator for the colors – currently the colors represent which WHO region each country belongs to
Size of Bubbles: You can change what the size of the bubble represents, currently it represents the size of a country’s population relative to one another