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					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               Global mean, 5.9912 mg/capita
           mg/capita
         60

                                      **Austria
                                      122.5037

         50




         40




         30


                                                                                            Albania               Ukraine
                                                                                                                                 Kyrgyzstan
                                                                                            0.9429                0.6418
                                                                                                                                   0.1048
         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
                                 WHO Regional Office for Southeast Asia (SEARO)
                                         2010 Morphine Consumption
                                                        SEARO mean, 0.1350 mg/capita        Global mean, 5.9912 mg/capita
           mg/capita
        1.5

                                          Bhutan
                                          3.9738




        1.0




                                                                         Sri Lanka
                                                                           0.3872


                                                                                                                            Bangladesh
        0.5
                                                                                                India
                                                                                                                              0.0502
                                                                                                0.0913




        0.0




Sources: International Narcotics Control Board; World Health Organization population data
By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012
   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:                                                                                   Pain & Policy Studies Group
Consumption data - International Narcotics Control Board;                                           University of Wisconsin
Population – United Nations World Population Prospects, 2010 Revision;                               Carbone Cancer Center
ME conversion factors – WHOCC Centre for Drug Statistics Methodology                             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

				
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