Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa: a report from the Global Opioid Policy Initiative (GOPI)

Ann Oncol. 2013 Dec;24 Suppl 11:xi14-23. doi: 10.1093/annonc/mdt499.


With nearly 1.1 billion inhabitants living in more than 50 countries, Africa is the world's poorest and most socioeconomically underdeveloped continent. Despite some advances for individual states, many African countries have very low opioid consumption and, overall, the continent has the lowest consumption per capita of any in the world. This article presents the findings of the first systematic study of the availability and accessibility of opioids for the management of cancer pain across the continent. Data are reported on the availability and accessibility of opioids for the management of cancer pain in 25 of 52 countries, with 744 million of the region's 1127 million people (66%) covered by the survey. Many countries had severely restricted formularies of opioids and only 15 of 25 had morphine available in oral IR, CR and injectable formulations. Even when opioids are on formulary they are often unavailable, and access is significantly impaired by widespread over-regulation that is pervasive across the region.

MeSH terms

  • Africa
  • Analgesics, Opioid / therapeutic use*
  • Developing Countries
  • Health Policy*
  • Health Services Accessibility / legislation & jurisprudence*
  • Healthcare Disparities
  • Humans
  • Morphine / therapeutic use*
  • Neoplasms / drug therapy
  • Pain / drug therapy*
  • Pain Management / methods
  • Palliative Care
  • Practice Patterns, Physicians' / legislation & jurisprudence


  • Analgesics, Opioid
  • Morphine