Cross-sectional pilot study to monitor the availability, dispensed prices, and affordability of opioids around the globe

J Pain Symptom Manage. 2014 Oct;48(4):649-59.e1. doi: 10.1016/j.jpainsymman.2013.12.237. Epub 2014 Apr 2.


Context: Opioids are essential medicines. The World Health Organization and Health Action International monitor the price of essential medicines. However, their surveys do not include opioids, and there is no information on their affordability.

Objectives: To provide information on access to pain treatment, as measured by the availability and dispensed price of five opioids in 13 formulations, and the affordability of oral immediate-release (IR) morphine.

Methods: The International Association for Hospice and Palliative Care members were distributed by their countries' Gross National Income (GNI) level using the World Bank categories, i.e., high income country (HIC), upper middle income country (UMIC), lower middle income country (LMIC), low income country (LIC), and randomized. A total of 10 participants were selected from each (n=40) domain. Participants were asked to identify a pharmacy located closest to a public facility that provides diagnosis/treatment for life-threatening conditions and report the lowest dispensed price of the smallest selling unit and strength of each formulation. Availability and median (Me) price were calculated for each. Affordability and percentage of international buyer price (IBP) were calculated for morphine oral solid IR.

Results: A total of 30 participants from 26 countries (response rate=75%) responded. Significant correlation was found between availability and GNI (range: 65-68% [HIC and LIC]; R=0.781; P<0.0001). Injectable and morphine oral solid sustained release (SR) were the most available (59% and 55%). Methadone (oral) was the least expensive (Me=0.5) followed by fentanyl (transdermal; Me=2.2). The Me price for morphine oral solid IR and ratios between dispensed and IBP were lower in HIC than in LMIC (price=0.03 vs. 0.16; ratio=2.23 vs. 0.03). Affordability for morphine oral solid IR was five days (Me=0.1; range=29-0.25).

Conclusion: Patients in LMIC and LIC have limited access to opioids, and there are subsidies in place for more expensive medications and formulations in all GNI levels, but not for morphine oral solid IR. Additional research is necessary to identify the reasons behind these findings.

Keywords: Essential medicines; accessibility; affordability; availability; opioids.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid / economics*
  • Cross-Sectional Studies
  • Developing Countries / economics*
  • Developing Countries / statistics & numerical data
  • Drug Costs
  • Drug Utilization Review
  • Fees, Pharmaceutical / statistics & numerical data*
  • Health Services Accessibility / economics*
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Internationality
  • Pain / drug therapy*
  • Pain / economics*
  • Pain / epidemiology
  • Pilot Projects
  • Poverty / economics*
  • Poverty / statistics & numerical data


  • Analgesics, Opioid