Global Opioid Policy Initiative

The ESMO-led Global Opioid Policy Initiative (GOPI) project evaluated the barriers to the availability & accessibility of opioids recommending that policy reform is necessary worldwide to manage severe cancer pain and avoid unnecessary suffering by patients

Adequate pain relief is a major goal of supportive and palliative care, especially for cancer patients. WHO statistics state that only around 6 million of the 40 million people in need of palliative care each year actually receive it due to unnecessarily restrictive regulatory barriers.

For these reasons, ESMO and the European Association for Palliative Care (EAPC) conducted a European and an international study on the availability of opioid analgesics for pain management using standards derived from the World Health Organization (WHO) and the International Narcotics Control Board (INCB).

These studies identified formulary deficiencies and excessive regulatory barriers which interfere with appropriate patient care in many countries.

The studies describe the availability and cost of opioids for cancer pain in each surveyed country, as well as the existing forms of regulatory restrictions.  They revealed that urgent and intensive efforts to increase access to opioids for legitimate medical use are needed.

The study is accompanied by summary infographics and infographics by geographical region.  A  10-point plan to reduce opioid access barriers proposes a solution for each barrier. It stresses the need for licensed physicians to have the required medical education, knowledge and skills to use opioid medications in the relief of cancer pain appropriately and safely as an integral part of high quality care. The plan recommends countries provide at a minimum the palliative care medicines on the WHO Model List of Essential Medicines (See Section 2: Medicines for Pain and Palliative Care) for opioid formulary, which should include oral codeine, immediate-release morphine, controlled-release morphine tablets and injectable morphine.

To address the barriers and improve access and availability of opioids, united efforts between all stakeholders, including international organisations, authorities and regulators, is extremely important, and require particular focus on countries with the most severe restrictions.

ESMO acknowledges and thanks all coordinating, collaborating and supporting project partners for their valuable contribution to this project which made it such a great success.

Global Impact

The ESMO Opioid Policy Initiatives served to support WHO and UN Resolutions on palliative care and the use of controlled substances such as opioids for legitimate medical use.

In 2014, ESMO, the UICC, the NCD Alliance and other endorsing partners issued a joint palliative care statement at World Health Assembly supporting the successful adoption of the WHO Resolution ‘Strengthening of palliative care as a component of integrated treatment throughout the life course’, which calls for increased access to palliative care to relieve unnecessary suffering worldwide.

In 2016, ESMO supported a successful international initiative to ensure that the Outcome Document of the United Nations General Assembly Special Session on the World Drug Problem contained recommendation to ensure access to controlled substances, such as opioids, for legitimate medical and scientific purposes, while preventing their diversion.

Next Step - Take Action

Read the patient stories of lack of availability of pain medicines leading to untold and unnecessary suffering worldwide.

Learn about the status of the availability of opioids in your country and region. Listen to the videos from across the globe and download the infographics representing the study results.

Drive implementation of the 10-point plan to reduce opioid access barriers in your country, using the resources from the study which include summary information and infographics of the study results by geographical region, as well as links to editorials, advocacy materials, videos and much more.