Understanding and Using INCB Opioid
Consumption Statistics:
Including Morphine Equivalence
8 August 2012
Martha Maurer, MSW, MPH, PhD
Pain & Policy Studies Group
World Health Organization Collaborating Center
for Policy and Communications in Cancer Care
University of Wisconsin Carbone Comprehensive Cancer Center
The Single
Convention
establishes two
mechanisms:
(1) statistical returns
system for narcotic
drugs, and
(2) estimates system
for narcotic drug
requirements.
UN Single Convention
Article 1, paragraph 2
For the purposes of this Convention
a drug shall be regarded as
“consumed” when it has been
supplied to any person or enterprise
for retail distribution, medical use or
scientific research; and
“consumption” shall be construed
accordingly.
UN Single Convention
Article 20, paragraph 1
The parties shall furnish to the
Board…statistical returns on forms
supplied by it in respect of the
following matters: …(c) consumption
of drugs.
Who is responsible?
PPSG Collaboration with INCB
- INCB publishes consumption
statistics annually
- Public INCB reports do not
include reported amounts that
are less than 500 g
- PPSG has a long-term
relationship with INCB
- PPSG receives complete
annual raw data, including
amounts less than 500 g, for
the most recent year
Uses of Consumption Statistics
-Identification of the opioids that are
available (i.e., manufacture or import
authorization) in a country
-An indicator of a country’s current and
historical ability to treat moderate to
severe pain
-A tool to evaluate the efforts to improve
opioid availability (i.e., following removal
of a barrier.)
Limitations of Consumption Statistics
- Some countries may not annually report or may
report incorrect statistics
- Not able to distinguish between different clinical
uses, e.g., methadone to treat pain vs. addiction
(dependence syndrome)
- Not able to distinguish between types of pain being
treated, e.g., acute vs. chronic
- Consumption for single drugs offers only a partial
view of a country’s ability to manage pain
Global Consumption of Morphine, 2010
mg/capita
Global Mean
5.9912
152 countries
**Austria’s consumption includes use of morphine for substitution therapy
Sources: International Narcotics Control Board; World Health Organization population data
By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012
Disparity in Consumption:
High vs. Low- and Middle-income countries (LMIC)
2010 Morphine Consumption (kg)
LMIC (10%)
High Income (90%)
WHO Regional Office for Europe (EURO)
2010 Morphine Consumption
EURO mean, 12.4285 mg/capita
mg/capita
Global mean, 5.9912 mg/capita
60
**Austria
122.5037
50
40
30
Albania
0.9429
20
10
0
**Austria includes data for substitution therapy
Sources: International Narcotics Control Board; World Health Organization population data
By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012
Ukraine
0.6418
Kyrgyzstan
0.1048
WHO Regional Office for Southeast Asia (SEARO)
2010 Morphine Consumption
SEARO mean, 0.1350 mg/capita
mg/capita
Global mean, 5.9912 mg/capita
1.5
Bhutan
3.9738
1.0
Sri Lanka
0.3872
0.5
0.0
Sources: International Narcotics Control Board; World Health Organization population data
By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012
India
0.0913
Bangladesh
0.0502
Morphine Equivalence (ME) statistic –
a more complete picture
PPSG developed a morphine equivalence (ME) statistic for each
principal opioid used to treat severe pain:
• Fentanyl
• Hydromorphone
• Methadone
• Morphine
• Oxycodone
• Pethidine
Allows for a comparison of the consumption of morphine to the
equianalgesic consumption of other medications
Total ME statistic represents in one metric the aggregate
consumption of these principal opioid analgesics used for severe
pain
Global Consumption in Morphine Equivalence (ME)
1980-2010, mg/person
Data sources:
Consumption data - International Narcotics Control Board;
Population – United Nations World Population Prospects, 2010 Revision;
ME conversion factors – WHOCC Centre for Drug Statistics Methodology
Pain & Policy Studies Group
University of Wisconsin
Carbone Cancer Center
WHO Collaborating Center
2009 Opioid Consumption in Morphine Equivalence
http://www.painpolicy.wisc.edu/
Opioid Consumption Motion Chart
http://www.painpolicy.wisc.edu/
PPSG’s Country Profiles
http://www.painpolicy.wisc.edu/internat/countryprofiles.htm
PPSG’s Country Profiles
Conclusions
• INCB data are an important source of data about opioid
availability around the world
• Prior to 1986 morphine consumption alone was a
reasonable indicator of total opioid consumption
• Subsequently morphine consumption alone less valid
indicator
• Morphine Equivalence statistics allow for equianalgesic
comparison across drugs
• Total morphine equivalence statistic represents
aggregate consumption of all principle opioids used for
severe pain