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The international collaborative project to evaluate the availability and accessibility of opioids for the management of cancer pain in 4 regions: Africa, Asia, Latin America and Middle East

Scandal of global proportions

Untreated cancer pain shown a ‘scandal of global proportions’ is the message emerging from the collaborative opioid survey coordinated by the European Association for Palliative Care (EAPC ), the European Association of Medical Oncology (ESMO); the Pain and Policy Studies Group (PPSG) International Program at the University of Wisconsin the Union for International Cancer Control (UICC); and the World Health Organization (WHO).

Results from the Global Opioid Policy Initiative (GOPI) project have just been published in Annals of Oncology and reveal that due to a lack of access to inexpensive and effective essential opioids more than 4 billion people (that is, over half the world population) live in countries where regulatory barriers leave cancer patients suffering excruciating pain.

“National governments must take urgent action to improve access to these medicines,” says the European Society for Medical Oncology, The initiative lead by Nathan Cherny, Chair of the ESMO Palliative Care Working Group, and James Cleary, Director of the Pain and Policy Studies Group in Wisconsin, USA coordinated of a group of 22 partners (* ) and followed up a previous European survey as recalled by Lukas Radbruch , past president of EAPC : “We did manage to take the experience from the EAPC/ESMO survey in Europe published three years ago, and turn this into a survey In developing countries in all regions of the world. And the contacts in these regions that we have from our international EAPC collaborations were a valuable addition to the survey”
“The next step is for international and national organisations working alongside governments and regulators to thoughtfully address the problems,” agree the lead authors of the study,

Take a look at the survey results here.
Get more advocacy resources here.
Watch video interview with Augusto Caraceni for the EAPC Research network here. Augusto Caraceni: “Decades since the recognition that morphine is essential for cancer patients, we still see how difficult it is to get appropriate opioids in so many countries. We should be able to refer to world standards, implying responsibility for governments, science and medical communities to set the priority of palliative care and pain management at a very high level”.

(*) the African Organisation for Research and Training in Cancer (AORTIC); African Palliative Care Association (APCA); Asia Pacific Hospice Palliative Care Network (APHN); Chinese Society of Clinical Oncology (CSCO); Foundation Akbaraly, Madagascar; Help the Hospices; Indian Association of Palliative Care (IAPC); International Association for Hospice and Palliative Care (IAHPC); Japanese Society of Medical Oncology (JSMO); Latin American and Caribbean Society of Medical Oncology (SLACOM); Latin American Association for Palliative Care (ALCP); Malaysian Oncology Society (MOS); Middle East Cancer Consortium (MECC); Multinational Association of Supportive Care in Cancer (MASCC); Myanmar Oncology Society; Open Society Foundation (OSF); Worldwide Palliative Care Alliance (WPCA).


The under-treatment of cancer pain has been identified as a major international public health crisis. This is particularly so in many of the developing economies of the world and in many parts of the under developed world. Despite efforts by many international organizations to address this problem, and some limited successes in isolated countries, in the big picture relatively little headway has been made.

Public health initiatives to address this problem are required but on a global and local scale. To be effective, public health initiatives must have a valid and reliable data as to what are the factors contributing to this health care dilemma. To date, collection of this data has been sporadic and not systematic. This lack of specific information may be one of the factors that have hampered progress to date.

All of the partners understand the value of this study as the only international one with data of this kind. The data will have major health implications for cancer patients around the world.

The partners see themselves as having and international mission and commitment to improving the fate of cancer patients with pain. Many partner organizations have a proven track record of data collection from the diverse geographic locations, data verification and collation, and report presentation. The partner organizations have experience in teaming with other potential collaborative partners in projects of this kind. This is the largest international collaboration program led by ESMO in any field and underscores the society’s commitment to supportive and palliative care on a global level as one of its major interests in an international setting. We see this as a project of major international significance that will both garner necessary data and mobilize a wide range of important collaborative partners to help address the issue of identifying and rectifying barriers to the availability of medication for the management of cancer pain in the developing world.

Project goals

The goal of this high profile project was to obtain reliable data regarding the availability and barriers to accessibility of opioids to cancer patients in Africa, Asia, the Middle East, Latin America. A survey questionnaire has benchmarked current standards against international standards set by WHO / International Narcotics Board, which implement and control UN drug conventions. The survey results have provided a critical resource for local, regional and international bodies addressing this vital human rights and public health issue of a person’s right to effective pain management

It is hoped that the clear elucidation of barriers to accessibility will facilitate effective lobbying and policy development to address the necessary regulatory reform required to improve the availability and accessibility of opioids for the management of severe cancer pain.

Aims & objectives

1. To evaluate the formal availability and cost to the consumer of the range of opioid drugs used in the management of cancer

2. To evaluate the regulatory barriers to the accessibility of opioid drugs for patients with cancer pain in each participating country

Results, outcomes

The survey results provide evidence of necessary policy reform to improve the management of severe cancer pain and to relieve unnecessary suffering worldwide. They also provide relevant worldwide data for both the WHO Access to Controlled Medications and WHO Cancer Control Programs.

The data, the most comprehensive of its kind, represents 83% of the population surveyed, it will be officially published in 2013 and supported by an international advocacy campaign to promote wider access to opioids to relieve unnecessary suffering worldwide.

The publication in Annals of Oncology, the regional and individual country reports, and the session at the Congresses are the main deliverables in this project.

The first results of the survey can be viewed here:

Access the data from your region:

International Advocacy Campaign

Please join our international advocacy campaign by downloading the brochure Global Access to Pain Relief: Evidence for Action and discussing it with your Ministry of Health


Project leader

Nathan Cherny
Chair ESMO Palliative Care Working Group
Jerusalem, Israel

Adamos Adamou
Chair ESMO Developing Countries Task Force

Coordinating partners

European Society for Medical Oncology (ESMO)

European Association Palliative Care (EAPC)

International Program at the Pain and Policies Studies Group,
University of Wisconsin Carbone Cancer Center

International Union Against Cancer (UICC)

World Health Organization (WHO)

Collaborating partners

Regional oncology societies: AORTIC, JSMO, CSCO, MOGA, SLACOM, AMAAC

Asia Pacific Hospice Palliative Care Network

African Palliative Care Association (APCA)

Middle East Cancer Consortium

International Association of Hospice and Palliative Care (IAHPC)

Latin American Association for Palliative Care (ALCP)

Multinational Association for Supportive Care in Cancer (MASCC)

Indian Palliative Care Group

Open Society Foundation (OSF)

World Palliative Care Alliance (WPCA)

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