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Pain & Policy Studies Group
"Improving global pain relief by achieving balanced access to opioids worldwide"
"Improving global pain relief by achieving balanced access to opioids worldwide"

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The Pain & Policy Studies Group (PPSG) is pleased to announce its annual release of new and updated global, regional, and national consumption data for Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone, and Pethidine.  Additionally, the morphine equivalence data on the global, regional and all country profile pages has been updated with the 2011 data.
As has been the case for many years, the 2011 INCB data illustrate the continuing disparities in morphine consumption between high and low- and middle-income countries:
high-income countries (as defined by the World Bank income-level classification) accounted for nearly 92% of medical morphine consumed in the world, but comprised only 17% of the total population. In contrast, low- and middle-income countries, representing the remaining 83% of the world’s population, consumed a mere 8% of the total morphine consumption. 
In 2011, there was a large and striking difference between the lowest amount of morphine consumed in a country (Nigeria: 0. 0032 mg/person) and the highest amount (Canada 87.48 mg/person*) *Austria reported 222.79 mg/person of morphine in 2011, but uses morphine for opioid substitution treatment, so the second highest, Canada, is listed 
56% of the countries reporting to INCB in 2011 consumed less than one milligram of morphine per person
These figures point to the large and continuing disparity in morphine consumption among countries, and provide further evidence of the inadequate global treatment of pain, especially in low- and middle-income countries.
However, there continue to be some notable increases in opioid consumption in a few countries where International Pain Policy Fellows have been making progress to improve the availability of opioids, such as morphine:
In Jamaica, the amount of morphine (mg/capita) consumed in 2011 represents nearly a seven-fold increase since 2001.  
Similarly, in Colombia, morphine consumption (mg/capita) has been stable since 2005, with a slightly increasing trend over the 7-year span.
The updated consumption data, including the morphine equivalence data, can be accessed at  
As always, we are grateful to the International Narcotics Control Board (INCB) for their continued collaboration and for providing annual updates of these important data.

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The PPSG is pleased to announce the 2012 International Pain Policy Fellowship. Applications are now being accepted from individuals who have an interest in drug policy advocacy for a two-year Fellowship program to improve availability of opioid analgesics for pain relief and palliative care in their low or mid-income country.


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People who suffer from severe chronic pain should have access to medicines that can effectively treat that pain. Doctors who prescribe such medications should do so with the benefit of the best information available to reduce the risk that such medications will be abused.

That, in essence, is the principle of balance, and for decades it has been the guiding principle of the UW Pain & Policy Studies Group (PPSG). But that is not the impression reporter John Fauber and the Milwaukee Journal Sentinel perpetrated with his Feb. 19 story.

The principle of balance recognizes the needs of patients in pain but also acknowledges the very real risks of dependence and abuse that such medications can pose – especially when they are prescribed irresponsibly. The UW School of Medicine and Public Health office that provides continuing professional education in health care offered a course, “Responsible Opioid Prescribing,” that is based on a book of the same name. Mr. Fauber took aim at the book and the course in an attempt to damage their credibility. But he left out important information and presented a highly distorted picture of the issue.

The UW School of Medicine and Public Health is the home of both the PPSG and the Office of Continuing Professional Development that sponsored the course, which aims to educate prescribers on the appropriate use of opioid medications. Those interested in this issue should read the January 2012 report of the Wisconsin State Council on Alcohol and other Drug Abuse. The report, compiled by a broad array of organizations that are addressing the problem of drug abuse in this state, points out that decades of data show that doctors have under-prescribed opiates for pain, and that such medications “offer tremendous benefits for patients when prescribed appropriately and used as prescribed.” The report also notes that ensuring patient access to these medications must be balanced with strategies for reducing the risk associated with these medications. To see the full report, click here:

That has been and continues to be the view of the UW Pain & Policy Studies Group and the goal of “Responsible Opioid Prescribing,” which relies on model guidelines for the appropriate use of these medications. The book was reviewed by a group of physicians and others experienced in pain management and is the best available guide to careful and thoughtful use of these medications.

Biased reporting not only hurts those unfairly targeted; it also compromises the public discussion of a very important public-health issue, and creates a dangerous environment that may set back the cause of effective pain treatment for thousands of patients. We hope that Mr. Fauber’s writings do not undo years of work aimed at improving care and reducing human suffering.

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New PPSG Blog: A Public Health Approach to Prescription opioid abuse and diversion.

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