90% of the morphine for pain relief is consumed by 10% of the world’s richest countries. Asia’s morphine per capita consumption is 36 times less than the global average. The roots of the 

 can be historically traced through the commodification of substances that were traditionally used as medicine.

Current policies – largely determined and imposed by the Global North, and influenced by the US narrative – are centred around licencing, prescription and control, disproportionately impacting the very countries that grow and manufacture the raw material. Western corporate capture continues to dictate and shape access, manifested in essential medicines lists and reimbursable insurance packages. 

The UN Drug Conventions place on all member states the dual obligation of two core imperatives – to prevent the non-medical use of controlled substances, and equally, to ensure adequate availability of controlled substances for medical and scientific purposes. Historical misalignment between these two core imperatives has produced two opioid crises – one of access and “the global pandemic of untreated pain,” and the other a more regionally defined epidemic of opioid use disorder and fatal overdose.

Excessive prescription opioids in some countries shouldn’t blind policy makers to the pain crisis in other countries. The singular focus on inappropriate use is not adequately evened out by the available evidence of successful achievement of balance, which should be models.

Let us focus on not only improved access, but 

 access to opioids. On well-calibrated, compassionate and 

 regulatory systems, and fit-for-purpose supply chains for controlled medicines, while simultaneously providing the guardrails of training and evidence-based information about the safe use of opioids for pain relief.

Bringing severe pain to an end

Smriti Rana has worked extensively in the field of palliative care in India since 2000 and more recently in the South East Asian Region. She advocates for the ‘Principle of Balance’ especially for the Global South, which seeks to ensure safe access to essential opioids for pain relief and other medical and scientific purposes, while preventing inappropriate use and diversion.

Smriti Rana ha trabajado mucho en el campo de los cuidados paliativos en la India desde el año 2000 y, más recientemente, en la región del sudeste asiático. Defiende el "Principio de Equilibrio", especialmente para el Sur Global, que busca garantizar un acceso seguro a los opioides esenciales para el alivio del dolor y otros fines médicos y científicos, evitando al mismo tiempo el uso inadecuado y el desvío.

Smriti Rana a beaucoup travaillé dans le domaine des soins palliatifs en Inde depuis 2000 et plus récemment dans la région de l'Asie du Sud-Est. Elle défend le "principe d'équilibre", en particulier pour les pays du Sud, qui vise à garantir un accès sûr aux opioïdes essentiels pour soulager la douleur et à d'autres fins médicales et scientifiques, tout en empêchant leur utilisation inappropriée et leur détournement.

Smriti Rana

IDPC Board member - Vice Chair

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Bringing severe pain to an end