More than five billion people—80% of the world’s population— live in countries where there is little or no access to opioid medicines such as morphine to treat moderate to severe pain.1 The World Health Organization’s list of essential medicines includes opioid analgesics, which also fall within the scope of the 1961 UN Single Convention on Narcotic Drugs, a treaty enacted to control the global supply of substances with potential for nonmedical use.

The independent quasijudicial International Narcotics Control Board monitors treaty compliance by approving national annual estimates of demand for controlled medicines.1 However, many countries submit inadequate estimates to meet clinical need, a situation the board is remedying through national and regional workshops.

Training is a priority because generations of doctors, pharmacists, and nurses have qualified with little knowledge of the indispensable role of controlled medicines in managing pain, especially in the relatively new disciplines of palliative care and treatment for substance use disorder.

This knowledge gap, together with the historical stigma of “fear of addiction” to opioids and unduly restrictive regulations, leaves patients with severe untreated pain.

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