title: Pain Treatment Continues To Be Inaccessible for Many Patients Around the Globe: Second Phase of Opioid Price Watch, a Cross-Sectional Study To Monitor the Prices of Opioids.
abstract: Strong opioids are a cornerstone of pain treatment, of which morphine is considered an essential analgesic by the World Health Organization. Access to opioids is limited, due to restrictive laws, limited education, and high prices. This is the second phase of a global project to monitor and report the dispensing price of opioids with the specific aim to expand and increase the information and allow further analysis of the challenges in their availability and affordability.
  
  
  
  Participants were asked to provide the lowest dispensing price of the smallest selling unit and lowest strength of five opioids in 13 formulations from a licensed pharmacy located closest to a public facility that provides diagnosis/treatment for life-threatening conditions. Data were collected from July 2015 to March 2016. Average availability, median (Me), and interquartile range (IQR) price were calculated for four gross national income (GNI) categories: higher income countries (HIC), upper middle income countries (UMIC), low middle income countries (LMIC), and low income countries (LIC). Affordability for one month of treatment with morphine immediate release (IR) tablet was also calculated.
  
  
  
  Data were submitted by 67 participants from 43 countries. Availability is strongly related to GNI level (Kruskal-Wallis tests p < 0.0001). Mean price for morphine IR tablets for a 30-day treatment within the GNI categories ranged between USD 3.28 and 376; average USD 78.5 (SD = 92, Me = 49.7, IQR = 80.5). Methadone oral liquid and hydromorphone slow release were the lowest priced (Me = 13.1, IQR = 70 and Me = 14.9, IQR = 89.1, respectively). Morphine IR tablet is less affordable in countries in lower income groups: LIC (mean = 54.1 ± 0.873, Me = 54.1); LMIC (mean = 21.1 ± 19.6, Me = 10.6); UMIC (mean = 14.1 ± 14.1, Me = 10.23); and HIC (mean = 3.2 ± 5.2, Me = 1.33). A negative correlation between the number of days and the countries' income category (Rs = -0.7; p < 0.001) was identified.
  
  
  
  Patients in LIC and MIC have less access to opioid medications. This highlights the need to continue efforts at improving access, availability, and affordability.
authors.affiliation: 1 Department of Palliative Medicine, RWTH University Aachen , Germany .
authors.forename: Tania
authors.initials: T
authors.lastname: Pastrana
authors.affiliation: 2 Fundacion FEMEBA (PAMP-FF) , San Nicolas, Argentina .|3 International Association for Hospice and Palliative Care (IAHPC) , San Nicolas, Argentina .
authors.forename: Roberto
authors.initials: R
authors.lastname: Wenk
authors.affiliation: 4 Department of Palliative Medicine, University Hospital Bonn and Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg , Bonn, Germany .
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
authors.affiliation: 5 School of Pharmacy, St. Johns University , New York, New York.
authors.forename: Ebtesam
authors.initials: E
authors.lastname: Ahmed
authors.affiliation: 6 International Association for Hospice and Palliative Care (IAHPC) , Houston, Texas.
authors.forename: Liliana
authors.initials: L
authors.lastname: De Lima
mesh_terms: D000701:Analgesics, Opioid / Q000191:economics* / Q000600:supply & distribution / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data; D018954:Drugs, Essential / Q000191:economics* / Q000600:supply & distribution / Q000627:therapeutic use; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D010146:Pain / Q000188:drug therapy / Q000191:economics*; D059408:Pain Management / Q000191:economics* / Q000379:methods; D014944:World Health Organization
chemical_list: D000701:Analgesics, Opioid; D018954:Drugs, Essential
keywords: accessibility; affordability; availability; essential medicines, opioids