Patient Access to Opioids for Pain Management in SEA with a Focus on Timor-Leste: A Scoping Review

Julia M Da Costa; Alexandra Martiniuk; Deborah Bateson; Clive Stevens; Betty B Chaar

doi:10.1016/j.jpainsymman.2025.11.006

Patient Access to Opioids for Pain Management in SEA with a Focus on Timor-Leste: A Scoping Review

J Pain Symptom Manage. 2026 Mar;71(3):e322-e335. doi: 10.1016/j.jpainsymman.2025.11.006. Epub 2025 Nov 12.

Authors

Julia M Da Costa¹, Alexandra Martiniuk², Deborah Bateson³, Clive Stevens⁴, Betty B Chaar⁵

Affiliations

¹ Sydney Pharmacy School, Faculty of Medicine and Health (J.M.D.C., B.B.C.), The University of Sydney, Sydney, New South Wales, Australia. Electronic address: julia.dacosta@sydney.edu.au.
² Sydney School of Public Health, Faculty of Medicine and Health (A.M.), The University of Sydney, Sydney, New South Wales, Australia; The George Institute for Global Health (A.M.), Sydney, New South Wales, Australia; Dalla Lana School of Public Health (A.M.), The University of Toronto, Toronto, Ontario, Canada.
³ Sydney Medical School, Faculty of Medicine and Health (D.B.), The University of Sydney, Sydney, New South Wales, Australia.
⁴ Department of Anthropology and Human Biology (C.S.), The University of Toronto, Toronto, Ontario, Canada.
⁵ Sydney Pharmacy School, Faculty of Medicine and Health (J.M.D.C., B.B.C.), The University of Sydney, Sydney, New South Wales, Australia.

PMID: 41232627
DOI: 10.1016/j.jpainsymman.2025.11.006

Abstract

Introduction: The majority of the world's population, including the Southeast Asia region, needs legitimate access to opioids, for the treatment of moderate to severe pain. The escalating incidence of cancer in Timor-Leste, the newest nation in the region, presents a significant challenge to healthcare systems particularly in pain management.

Objectives: To examine the literature on patients' access to effective pain management in Southeast Asian countries with a focus on Timor-Leste.

Methods: Four databases and records were searched on January 1, 1999 to May 15, 2025, including Scopus, MEDLINE via Ovid, Embase via Ovid, and CINAHL via EBSCO.

Results: Fifty studies were analyzed using the World Health Organization's (WHO) health system framework and the Levesque conceptual framework for healthcare access. Over one-third of the studies included were carried out in Thailand, and only two studies, including a report, were conducted in Timor-Leste. Approximately 70% of the studies were categorized under service delivery, workforce, and availability of medicines, financing and affordability aspects of opioids access were the least category explored.

Discussion: The literature revealed significant barriers impeding adequate access to pain management, including regulatory obstacles, a lack of trained healthcare workers, medications' availability, deficiencies in pain assessment, affordability, and resistance to opioid treatment among both patients and healthcare providers due to stigma and cultural beliefs.

Conclusion: As a country that is in the process of strengthening its healthcare sector, it is crucial for Timor-Leste to understand regional research for effective intervention to improve access to pain management policies and practices.

Keywords: Access; Southeast Asia; Timor-Leste; opioids; pain management.

Publication types

Scoping Review
Review

MeSH terms

Analgesics, Opioid* / therapeutic use
Health Services Accessibility*
Humans
Pain Management* / methods
Pain* / drug therapy
Timor-Leste

Substances

Analgesics, Opioid