The Single Convention on Narcotic Drugs, 1961, as amended by the 1972 Protocol amending the Single Convention on Narcotic Drugs, 1961, requires national governments to annually report opioid consumption statistics to the INCB. Each year the INCB publishes these data in a technical report. For questions about these data, please email Asra Husain at: firstname.lastname@example.org
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These data represent the amounts of opioids distributed legally in a country for medical and scientific purposes to those healthcare institutions and programs that are licensed to dispense to patients, such as hospitals, nursing homes, pharmacies, hospices and palliative care programs. Consumption does not refer to the amounts dispensed to, or used by, patients, but rather to amounts distributed to the retail level.
The opioid consumption data are displayed in milligrams per capita (or per person), which is calculated by first converting the raw consumption data we receive from INCB from kilograms to milligrams and then dividing by the population of the country for a particular year. United Nations population data is used. This provides a population-based statistic that allows for comparisons between countries.
The INCB’s published technical reports do not provide values for quantities of opioids consumed that are less than 1kg.
The INCB uses consumption statistics to:
- monitor compliance of governments with the provisions of the Single Convention,
- identify trade discrepancies between importing and exporting countries,
- identify trends in the worldwide availability of opioids and other drugs for medical needs, and
- monitor and maintain a global balance of supply and demand of opioids for medical and scientific needs.
Opioid consumption statistics also have several useful applications for advocates, policy-makers, or anyone interested in improving opioid availability. They can be used to:
- identify whether a country has available opioids that can relieve moderate to severe pain,
- learn whether the amounts indicate any substantial current consumption or progress over time, and
- evaluate the outcome of efforts to improve opioid availability
Consumption statistics provided in INCB reports have several limitations that should be considered when using them as an indicator of opioid availability for pain management:
- some governments report late, do not report for a particular year or period, or make inaccurate reports, all of which result in incomplete or invalid information for that year. These deficiencies may be corrected in subsequent years as the INCB receives more complete data from the government;
- consumption statistics do not distinguish between clinical uses for opioids, as in methadone for treatment of pain or dependence syndrome, or fentanyl for analgesia or anesthesia;
- consumption statistics do not distinguish between programs that use opioid analgesics, such as hospitals and hospices;
- consumption statistics do not indicate which products or dosage forms of an opioid are available within a country (i.e., whether an opioid is in oral, parenteral or transdermal form) and
- consumption statistics are not a valid indicator of the quality of pain control in a country.
Historically, the WHO has considered a country’s annual consumption of morphine to be an indicator of the extent that opioids are used to treat severe cancer pain and an index to evaluate improvements in pain management. However, over the past 20 years additional opioid analgesic medications and formulations, such as the fentanyl patch, hydromorphone, and sustained-release oxycodone, have been introduced in global and national markets and should be considered when studying opioid consumption in a country, region, and globally.
Using the INCB data it receives annually, and applying conversion factors from the WHO Collaborating Center for Drugs Statistics Methodology, PPSG developed a Morphine Equivalence (ME) metric, adjusted for population, for 6 principal opioids used to treat moderate to severe pain:
- Oxycodone, and
The ME allows for equianalgesic comparisons between countries of the aggregate consumption of these principal opioids (total ME), thereby providing a more complete picture of a country’s capability to treat moderate to severe pain than is possible by analyzing morphine consumption alone. ME data are now provided on the global, regional and all country profile pages and will be annually updated as new data become available.
Morphine Equivalence without Methadone
Studies of the morphine equivalence metric have demonstrated that methadone often significantly contributes to a country’s Total ME, but a clear interpretation of this effect is challenging because of the common dual uses of this opioid:
- medication-assisted treatment of opioid dependence syndrome, and
- managing moderate to severe pain as part of palliative care.
It is likely, that much, if not most, of the methadone is used for medication assisted treatment of opioid dependence syndrome in many countries and therefore is not a good indication of a country’s capacity to relieve pain.
Therefore, in an effort to more precisely illustrate a region or country’s capacity for pain relief, we have added graphs representing morphine equivalence that do not include methadone, denoted as ME minus methadone.