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Understanding and Using INCB Opioid Consumption Statistics: Including Morphine Equivalence 8 August 2012

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

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Understanding and Using INCB Opioid Consumption Statistics: Including Morphine Equivalence 8 August 2012

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  1. Understanding and Using INCB Opioid Consumption Statistics: Including Morphine Equivalence 8 August 2012 Martha Maurer, MSW, MPH, PhD Pain & Policy Studies GroupWorld Health Organization Collaborating Center for Policy and Communications in Cancer Care University of Wisconsin Carbone Comprehensive Cancer Center

  2. The Single Convention establishes two mechanisms: (1) statistical returns system for narcotic drugs, and (2) estimates system for narcotic drug requirements.

  3. UN Single ConventionArticle 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.

  4. UN Single ConventionArticle 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.

  5. Who is responsible?

  6. - 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 PPSG Collaboration with INCB

  7. 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.) Uses of Consumption Statistics

  8. 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 Limitations of Consumption Statistics

  9. mg/capita Global Consumption of Morphine, 2010 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

  10. Disparity in Consumption: High vs. Low- and Middle-income countries (LMIC) 2010 Morphine Consumption (kg) LMIC (10%) High Income (90%)

  11. WHO Regional Office for Europe (EURO)2010 Morphine Consumption mg/capita **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

  12. WHO Regional Office for Southeast Asia (SEARO)2010 Morphine Consumption mg/capita Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012

  13. 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 • TotalMEstatistic represents in one metric the aggregate consumption of these principal opioid analgesics used for severe pain Morphine Equivalence (ME) statistic – a more complete picture

  14. 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

  15. http://www.painpolicy.wisc.edu/ 2009 Opioid Consumption in Morphine Equivalence

  16. Opioid Consumption Motion Charthttp://www.painpolicy.wisc.edu/

  17. PPSG’s Country Profiles http://www.painpolicy.wisc.edu/internat/countryprofiles.htm

  18. PPSG’s Country Profiles

  19. 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 Conclusions

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