Methodology for estimating need and consumption of medicinal opioids

This page describes the analysis of some basic data to describe the landscape of access to pain relief.

PAIN TREATMENT

Morphine equivalent is a metric to standardize doses of opioids by potency and allow combination and comparison of different medicinal opioids. It is calculated as

ME=(1*morphine)+(83.3*fentanyl)+(5*hydromorphone)+(1.33*oxycodone)+(0.25*pethidine)+(4*methadone)

This equation is taken from the ratios of the defined daily dose (oral dosing for all except fentanyl, which is trans-dermal) as described by the World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology (1).

Because of methadone's widespread use as opioid substitution therapy, non-methadone morphine equivalent is also used in some instances and is calculated as

NME=(1*morphine)+(83.3*fentanyl)+(5*hydromorphone)+(1.33*oxycodone)+(0.25*pethidine)

Opioid consumption data are from taken a dataset provided by the International Narcotics Control Board (INCB) with the release of their annual report for narcotics consumption (2). For each drug, the average of consumption data over the last 3 years (2010-2012) is used. Data are also published on the INCB website (3)(4)(5).

DEATHS IN PAIN

It is assumed that 80% of cancer deaths and 50% of HIV deaths require morphine and that the average morphine required for each death in pain is 67.5 mg/day for 91.5 days (6). The number of deaths from cancer is taken from the International Agency for Research on Cancer’s GLOBOCAN 2012 dataset (7). The number of deaths from HIV is taken from the WHO Global Health Observatory Data Repository for 2012 (8). For countries that are not included in the repository dataset for 2012, data are taken from the most recent data available, as documented in the Central Intelligence Agency (CIA) World Factbook (9).

UNTREATED DEATHS IN PAIN

It is assumed that all of the morphine in the country is used for deaths in pain due to cancer and HIV. The number of untreated deaths in pain is calculated by subtracting the number of deaths in pain that could be treated with the total morphine equivalent in the country from the total number of deaths in pain.

REFERENCES

  1. WHO Collaborating Centre for Drug Statistics Methodology [Internet]. 2014 [cited 2014 May 12]. Available from: http://www.whocc.no/atc_ddd_index/
  2. International Narcotics Control Board. Dataset: Opioid consumption statistics 2007-2012. 2014.
  3. United Nations International Narcotics Control Board. Narcotic Drugs: Estimated World Requirements for 2014; Statistics for 2012 [E/INCB/2012/1] [Internet]. 2013 [cited 2014 May 12]. Available from: http://www.incb.org/incb/en/narcotic-drugs/Technical_Reports/2013/narcotic-drugs-technical-report-2013.html
  4. United Nations International Narcotics Control Board. Narcotic Drugs: Estimated World Requirements for 2013; Statistics for 2011 [E/INCB/2012/2] [Internet]. [cited 2014 May 12]. Available from: http://www.incb.org/incb/en/narcotic-drugs/Technical_Reports/2012/narcotic-drugs-technical-report_2012.html
  5. United Nations International Narcotics Control Board. Narcotic Drugs: Estimated World Requirements for 2012; Statistics for 2010 [E/INCB/2011/1] [Internet]. 2011 [cited 2014 May 12]. Available from: http://www.incb.org/incb/en/narcotic-drugs-technical-report_2011.html
  6. Foley KM, Wagner JL, Joranson DE, Gelband H. Pain Control for People with Cancer and AIDS. Disease Control Priorities in Developing Countries. 2nd ed. New York: Oxford University Press; 2006. p. 981–94.
  7. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012 [Internet]. 2014 [cited 2014 May 12]. Available from: http://globocan.iarc.fr/Default.aspx
  8. World Health Organization. Global Health Observatory Data Repository [Internet]. 2014 [cited 2014 May 12]. Available from: http://apps.who.int/gho/data/node.main.623
  9. Central Intelligence Agency. The World Factbook [Internet]. 2014 [cited 2014 May 12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/