title: Multivariate analysis of countries' government and health-care system influences on opioid availability for cancer pain relief and palliative care: more than a function of human development.
abstract: BACKGROUND
  Many international governmental and nongovernmental organizations regard unrelieved cancer pain as a significant global public health problem. Although opioids such as morphine are considered essential medicines in the provision of palliative care and for treating cancer pain, especially when the pain is severe, low- and middle-income countries often lack such medications.
  
  
  OBJECTIVE
  The primary aim of this study was to examine countries' government and health-care system influences on opioid availability for cancer pain and palliative care, as a means to identify implications for improving appropriate access to prescription opioids.
  
  
  METHODS
  A multivariate regression of 177 countries' consumption of opioids (in milligrams/death from cancer and AIDS) contained country-level predictor variables related to public health, including Human Development Index, palliative care infrastructure, and health system resources and expenditures.
  
  
  RESULTS
  Results were highly explanatory (adjusted R(2) = 82%) and Human Development Index was the most predictive variable when controlling for all other factors in the statistical model (B = 11.875, confidence interval = 10.216, 13.534, p < 0.0001).
  
  
  CONCLUSIONS
  Study findings demonstrate that a limited number of predictor variables characterizing a country's government and health-care system infrastructure can explain its opioid consumption level, with the greatest influence being very high Human Development Index. However, Human Development Index is not the most policy-relevant factor, and this finding should be reconciled against the reality that many countries with low or medium Human Development Index have succeeded in creating and sustaining a health-care system to strengthen cancer pain care and palliative care, including through the appropriate use of essential prescription opioids.
authors.affiliation: Pain & Policy Studies Group, University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Gilson
authors.forename: Martha A
authors.initials: MA
authors.lastname: Maurer
authors.forename: Virginia T
authors.initials: VT
authors.lastname: Lebaron
authors.forename: Karen M
authors.initials: KM
authors.lastname: Ryan
authors.forename: James F
authors.initials: JF
authors.lastname: Cleary
mesh_terms: D000701:Analgesics, Opioid / Q000600:supply & distribution / Q000627:therapeutic use*; D006297:Health Services Accessibility; D006801:Humans; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D012959:Socioeconomic Factors
chemical_list: D000701:Analgesics, Opioid