RT Journal Article
SR Electronic
T1 Relation between opioid consumption and inclusion of opioids in 137 national essential medicines lists
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e003563
DO 10.1136/bmjgh-2020-003563
VO 5
IS 11
A1 Georgia C Richards
A1 Jeffrey K Aronson
A1 Carl Heneghan
A1 Kamal R Mahtani
A1 Constantinos Koshiaris
A1 Nav Persaud
YR 2020
UL http://gh.bmj.com/content/5/11/e003563.abstract
AB Introduction Opioids are deemed essential medicines by the World Health Organization (WHO). However, many countries have inadequate access to them. Whether including opioids in national essential medicines lists (EMLs) influences national opioid consumption has not been evaluated.Methods We conducted a cross-sectional study to determine whether the listing of opioids in national EMLs was associated with consumption. We quantified the numbers and types of all opioids included in 137 national EMLs, for comparison with opioids in the WHO’s Model List of Essential Medicines. Using the International Narcotics Control Board (INCB) consumption statistics for 2015–2017, we assessed the relation between annual mean opioid consumption (mg/person) and the numbers of opioids included in EMLs, controlling for region, population, healthcare expenditure, life expectancy, gross domestic product, human development and corruption.Results Five opioids were included in the 20th edition of the WHO’s Model List of Essential Medicines: codeine, fentanyl, loperamide, methadone and morphine. On average, countries’ lists included significantly (p<0.05) more opioids than the WHO’s Model List. However, there were wide variations in the numbers (median 6 opioids; IQR: 5–9) and types (n=33) of opioids included in national EMLs. Morphine (95%), fentanyl (83%) and codeine (69%) were the most commonly included opioids. Most national EMLs were out of date (median publication date: 2011, IQR: 2009–2013). After adjusting for country characteristics, there was no relation between mean opioid consumption and the number of opioids in EMLs.Conclusions Including opioids in national EMLs was not associated with consumption. National EMLs should be regularly updated to reflect the availability of opioids and the populations’ needs for managing pain.