The Single Convention on Narcotic Drugs- Implementation in Six Countries: Albania, Bangladesh, India, Kyrgyzstan, Sri Lanka, Ukraine A MONOGRAPH PREPARED FOR: International Pain Policy Fellowship Training Madison, Wisconsin, USA 6-10 August 2012 University of Wisconsin Pain & Policy Studies Group Carbone Cancer Center World Health Organization Collaborating Center for Pain Policy and Palliative Care 1300 University Ave, 6152 MSC Madison, Wisconsin 53706 USA http://www.painpolicy.wisc.edu Not for further distribution. Supported by: LIVESTRONG Open Society Foundations
Citation: Pain & Policy Studies Group. The Single Convention on Narcotic Drugs - Implementation in Six Countries: Albania, Bangladesh, India, Kyrgyzstan, Sri Lanka, Ukraine. University of Wisconsin Pain & Policy Studies Group/WHO Collaborating Center for Pain Policy and Palliative Care; Madison, Wisconsin, USA. 2012. (Monograph)
Table of Contents I. ABOUT THE PAIN & POLICY STUDIES GROUP... 1 II. INTRODUCTION: INTERPRETING INFORMATION IN THIS MONOGRAPH... 2-4 A. Why are opioid consumption statistics important?... 2 B. Governments are the source of required reports to the INCB... 3 C. Competent national authorities... 4 D. Status of adherence to conventions, receipt of statistics and estimates... 4 III. OVERVIEW OF OPIOID CONSUMPTION... 4-6 A. Global Consumption... 4 B. Regional Consumption... 5 C. National Consumption... 5 D. Morphine Equivalence: Global and National Trends, 1980-2010... 6 IV. TABLE 1. COMPETENT NATIONAL AUTHORITIES... 7 V. TABLE 2. STATUS OF ADHERENCE TO CONVENTIONS, RECEIPT OF STATISTICS, AND ESTIMATES... 8 VI. GLOBAL CONSUMPTION TRENDS, 1980-2010... 9-10 Graph 1. Morphine, oxycodone, pethidine, methadone... 9 Graph 2. Fentanyl, hydromorphone... 10 VII. GLOBAL CONSUMPTION, 2010... 11-22 Graph 3 and Table 3. Morphine... 11-12 Graph 4 and Table 4. Fentanyl... 13-14 Graph 5 and Table 5. Hydromorphone... 15-16 Graph 6 and Table 6. Oxycodone... 17-18 Graph 7 and Table 7. Pethidine... 19-20 Graph 8 and Table 8. Methadone... 21-22 VIII. REGIONAL CONSUMPTION, 2010... 23-58 Graphs 9-14. AFRO... 23-28 Graphs 15-20. AMRO... 29-34 Graphs 21-26 EMRO... 35-40 Graphs 27-32. EURO... 41-46 Graphs 33-38. SEARO... 47-52 Graphs 39-44 WPRO... 53-58 IX. NATIONAL CONSUMPTION TRENDS, 1980-2010... 59-76 Graphs 45-50. Albania... 59-61 Graphs 51-56. Bangladesh... 62-64 Graphs 57-62. India... 65-67 Graphs 63-68. Kyrgyzstan... 68-70 Graphs 69-74. Sri Lanka... 71-73 Graphs 75-80. Ukraine... 74-76 X. MORPHINE EQUIVALENCE: GLOBAL AND NATIONAL TRENDS, 1980-2010... 77-90 Graph 81 and Table 9. Global... 77-78 Graph 82 and Table 10. Albania... 79-80 Graph 83 and Table 11. Bangladesh... 81-82 Graph 84 and Table 12. India... 83-84 Graph 85 and Table 13. Kyrgyzstan... 85-86 Graph 86 and Table 14. Sri Lanka... 87-88 Graph 87 and Table 15. Ukraine... 89-90
I. ABOUT THE PAIN & POLICY STUDIES GROUP The Pain & Policy Studies Group (PPSG), a global research program at the University of Wisconsin Carbone Cancer Center, is committed to promoting pain relief through effective public policy, communications, and outreach efforts. The PPSG mission is to improve global pain relief by achieving balanced access to opioids worldwide. Much of its work focuses on improving the appropriate medical use of opioid analgesics (such as morphine), which are essential for palliative care, by identifying and addressing legislative and regulatory barriers. Over the last two decades, PPSG has developed an abundance of experience, and expertise, which it uses to provide policy and research resources to colleagues around the world. The PPSG s efforts have focused historically on researching and disseminating information about global under-treatment of pain, disparities in global opioid consumption, methods to identify and address policy barriers at the national level, and providing ongoing technical assistance to colleagues to help them improve availability and access to opioids in their country. Most recently, the PPSG has developed interactive opioid consumption maps, which gives an immediate visual image of the variation in consumption of opioids across the world; and interactive graphs for exploring opioid consumption trends allowing users to explore relationships over time between opioid consumption and other country characteristics, such as Gross Domestic Product or Human Development Index. The PPSG is nationally and internationally recognized for its work and leadership to improve availability of opioid pain medicines, having been at the forefront of such efforts since its creation in 1996. 1
II. INTRODUCTION: INTERPRETING INFORMATION IN THIS MONOGRAPH A. Why are opioid consumption statistics important? In 1986, the WHO concluded that most pain due to cancer could be relieved using a simple analgesic method and that every national government should institute a cancer pain relief programme. 1 The WHO analgesic method has also been endorsed for relief of pain due to HIV/AIDS. 2 The analgesic method depends on the availability of, and patient access to, medicines that can relieve severe pain, such as morphine and other opioids. Recognizing that opioids are controlled strictly as narcotic drugs because of a potential for abuse and drug dependence, WHO recommended that governments (a) evaluate their drug control policies and practices to ensure that patients receive the opioid medications that are necessary for pain relief, and (b) encourage health care workers to report to the appropriate authorities any instance in which oral opioids are not available for cancer patients. Indeed, the fact that opioids are narcotic drugs regulated by governments is why those interested in pain relief and palliative care for HIV/AIDS and cancer must learn about the drug regulatory system and prepare to work with governments. For nearly three decades there has been clear guidance from United Nations (UN) health and regulatory agencies regarding the need for governments to address opioid availability and accessibility. These high-level bodies have repeatedly called on governments to identify and remove barriers that block patient access to opioid analgesics. At a recent meeting of the UN Commission on Narcotic Drugs in March 2010, there was a resolution adopted called Promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse, 3 noting the concern that some governments need to take specific measures to ensure adequate access to opioid analgesics in line with the international drug control conventions. In September 2011, the UN General Assembly called attention to the growing international epidemic of non-communicable diseases (NCDs) (including cancer) by holding a high-level Meeting on the Prevention and Control of NCDs. The resulting Political Declaration acknowledges the importance of providing palliative care for people with NCDs, and calls for the use of affordable medicines (including generics) for palliative care. 4 Additionally, non-governmental professional and advocacy groups have made numerous declarations over the years calling on healthcare professionals and governments to improve pain and palliative care, by addressing barriers to the availability of opioids to manage pain. A notable example of such efforts is the World Cancer Declaration from 2008 in which the 1 World Health Organization. Cancer pain relief. Geneva, Switzerland: World Health Organization; 1986. 2 World Health Organization HIV-AIDS. Palliative Care. Geneva, Switzerland: World Health Organization; 2004. http://www.who.int/hiv/topics/palliative/palliativecare/en/index.html 3 United Nations Economic and Social Council. Promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse; Resolution 53/4. Report on the fifty-third session of the Commission on Narcotic Drugs; 8-12 March 2010; Agenda item 9; Implementation of the international drug control treaties. 2010. 4 United Nations General Assembly. Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. Draft resolution submitted by the President of the General Assembly at the sixty-sixth session; Agenda item 117; September. 2011. New York, NY, United Nations. 2
Union for International Cancer Control called for effective pain control measures to be available universally to all cancer patients when needed. 5 Consumption statistics for opioids are one indicator of the capability of a country to treat moderate to severe pain. Opioid consumption statistics can also be used to evaluate the outcomes of efforts to improve opioid availability. Morphine is frequently used as a principal indicator because morphine is the most widely available opioid analgesic for moderate to severe pain. Fentanyl, hydromorphone, methadone and oxycodone are included in this publication because they are appropriate to treat moderate to severe pain, and they have become increasingly available globally over the last decade. Consumption trends for pethidine are included in this monograph because (1) although pethidine is no longer recommended for chronic pain, it is still widely used; and (2) since pethidine is subject to the same legal controls as other strong opioids, its consumption is an indication that, from a legal standpoint, the country should be able to obtain other opioids for severe pain, such morphine, fentanyl or oxycodone. Finally, other opioids such as tramadol and codeine are not included because they are not capable of relieving severe pain. B. Governments are the source of required reports to the INCB The International Narcotics Control Board (INCB) is the international narcotic regulatory authority for the United Nations; it monitors national governments implementation of the 1961 Single Convention on Narcotic Drugs. This treaty, to which most governments are party, governs the cultivation, movement and availability of narcotic drugs for medical purposes in the world. According to the Single Convention, narcotic drugs are indispensable for the treatment of pain and suffering, and governments should ensure their adequate availability for all medical and scientific purposes, while preventing diversion and abuse. Governments must annually provide INCB an estimate of the amounts of opioids that will be required to satisfy all medical and scientific needs in the next year. Although INCB confirms the estimate as the amount authorized to be used in the country, the estimate itself is determined and submitted by the government. The INCB does not reduce governments estimates to less than is needed. In fact, if unanticipated needs arise during the year, the INCB encourages governments to submit a supplemental request, which it can confirm in a short amount of time. Recently, in 2012, INCB and WHO published a Guide for governments on estimating requirements for controlled substances, including opioids. 6 Governments also report prior year opioid consumption statistics to the INCB which compiles them into annual statistical reports. 7 Consumption refers to the amounts distributed to the retail level in a country, i.e., to those institutions and programs that are licensed to dispense to patients. Consumption is reported by anhydrous weight of the active drug, not including the salt; 5 Union for International Cancer Control. World Cancer Declaration. 2008. http://www.uicc.org/declaration 6 International Narcotics Control Board, World Health Organization. Guide on Estimating Requirements for Substances under International Control. Vienna: United Nations, 2012. http://www.incb.org/documents/guide_on_estimates/guide_on_estimating_english_ebook.pdf 7 International Narcotics Control Board. Narcotic Drugs: Estimated World Requirements for 2012- Statistics for 2010. New York, NY: United Nations; 2011. http://www.incb.org/incb/en/narcotic-drugs-technicalreport_2011.html 3
for example, the amount reported for morphine does not include the weight of the salt (sulfate or chloride), just the morphine base. Some countries do not report consumption statistics. In addition, INCB does not publish reports of consumption less than 0.5 kilogram. However, the PPSG obtains complete annual data from the INCB and makes them available because there are many countries where small amounts are important and because any amount of morphine consumed demonstrates that the government approved its use. C. Competent national authorities Each government that is party to the Single Convention designates an office that is responsible for carrying out required functions, including making estimates and reporting consumption statistics. 8 Table 1 provides a list of the names and contact information for the National Competent Authority in the 6 Fellows countries. These offices may be located in the Ministry of Health in the pharmaceutical department or in the national food or drug control agency. They are the principal national authority for ensuring that opioid analgesics are adequately available for medical and scientific purposes and for submitting the required documents to the INCB. These offices receive reports from the INCB, including technical reports that encourage all governments to examine national policies and administrative procedures for barriers and to consult with health professionals in formulating realistic estimates. However, sometimes these offices do not have adequate personnel to administer these and other important responsibilities in the area of drug control and availability. D. Status of adherence to conventions, receipt of statistics and estimates Table 2 presents information that the INCB compiles annually in an effort to inform the public about whether national governments are adhering to their obligations under the Single Convention. Information is provided for the 6 Fellows countries. From these data, it can be seen that all 6 governments are parties to the Single Convention, 1961, and as amended in 1972, and submitted all required reports for the most recent report. III. OVERVIEW OF OPIOID CONSUMPTION A. Global Consumption Trend in kilograms Graphs 1-2 provide the global consumption trends for morphine, fentanyl, hydromorphone, oxycodone, pethidine and methadone for 1980 2010 which presents the big picture of the consumption of opioid analgesics. Prior to 1986, the consumption of morphine throughout the world was low and stable. After 1986, the total global consumption of morphine began to increase as some national governments and health professionals adopted the WHO analgesic method and as new opioid products became available more widely. The consumption of 8 United Nations. Competent national authorities under the international drug control treaties, 2011. New York, NY: United Nations; 2012. http://www.unodc.org/documents/commissions/cna2010/11-88334_ebook.pdf 4
pethidine exceeded that of morphine, but has slowly declined as other opioids have become more widely used. Recently, there are indications that consumption of morphine is being offset in some countries by the advent of other opioid analgesics such as fentanyl, hydromorphone, methadone and oxycodone. Although some countries use morphine mainly for cancer pain, morphine may be used for other pain, including acute, post-operative, AIDS, and for chronic non-cancer conditions. In addition, some countries may use strong opioids including morphine and methadone for substitution treatment of drug dependence. 2010, in milligrams per capita Graphs and corresponding Tables 3-8 present global 2010 consumption statistics in milligrams per capita (dividing the total amount of drug consumed in kilograms, by the country population [in millions] of the country) for morphine, fentanyl, hydromorphone, oxycodone, pethidine and methadone. This provides a population-based statistic that allows for comparisons between countries and in relation to the global mean. The consumption of opioids varies greatly from country to country. Fellows countries that reported statistics are highlighted. The vast majority of morphine is consumed in industrialized countries which represent a small part of the world s population. The remaining countries of the world (a number of developed countries and all of the developing countries) consumes comparatively little for 2010. In a recent report, the INCB stated, "Global consumption of opioid analgesics for the treatment of moderate to severe pain...increased by more than two and one half times during the past decade...the global figures hide large and enduring disparities in the consumption of opioid analgesics among countries. In 2008, Australia, Canada, New Zealand, the United States and the member States of the European Union together accounted for more than 96 per cent of global consumption of fentanyl, 90 per cent of global consumption of morphine and 98 per cent of global consumption of oxycodone. Although there is sufficient supply of opiate raw materials worldwide, access to opioid analgesics is non-existent or almost non-existent in many countries and in entire regions." (p. 19) 9 B. Regional Consumption Graphs 9-44 present the WHO regional pictures of the consumption of morphine, fentanyl, hydromorphone, oxycodone, pethidine and methadone in milligrams per capita for the WHO Regional Office for Africa (AFRO), WHO Pan American Health Organization (AMRO/PAHO), WHO Regional Office for the Easter Mediterranean (EMRO), WHO Regional Office for Europe (EURO), WHO Regional Office for South-East Asia (SEARO), and WHO Western Pacific Region (WPRO) regions respectively. C. National Consumption Graphs 45-80 present morphine, fentanyl, hydromorphone, oxycodone, pethidine and methadone consumption trends for the 6 Fellows countries: Albania, Bangladesh, India, Kyrgyzstan, Sri Lanka, Ukraine. These data are expressed in milligrams per capita. A value of 0 indicates that 9 International Narcotics Control Board. Report of the International Narcotics Control Board for 2009. New York, NY: United Nations; 2010. http://www.incb.org/incb/en/annual-report-2009.html 5
no report was received by the INCB for that year. D. Morphine Equivalence: Global and National Trends, 1980-2010 Historically, the WHO has considered a country s annual consumption of morphine to be an indicator of the extent that opioids are used to treat severe cancer pain and an index to evaluate improvements in pain management. However, over the past 20 years additional opioid analgesic medications and formulations, such as the fentanyl patch, hydromorphone, and sustained-release oxycodone, have been introduced in global and national markets and should be considered when studying opioid consumption in a country, region, and globally. Using the INCB data it receives annually, and applying conversion factors from the WHO Collaborating Center for Drugs Statistics Methodology, PPSG developed a Morphine Equivalence (ME) metric, adjusted for population, for 6 principal opioids used to treat moderate to severe pain: fentanyl, hydromorphone, methadone, morphine, oxycodone, and pethidine. The ME allows for equianalgesic comparisons between countries of the aggregate consumption of these principal opioids (total ME), thereby providing a more complete picture of a country s capability to treat moderate to severe pain than is possible by analyzing morphine consumption alone. Graph 81 presents the Global ME opioid consumption trend from 1980-2010 in milligrams per person, with the corresponding Table 9. The ME trend graph illustrates that the ME consumption of fentanyl, oxycodone, and methadone has been higher than morphine since the early 1990s. Graphs 82-87 and corresponding tables 10-14 present the ME opioid consumption trend data (1980-2010) for each of the Fellows' countries. 6
IV. TABLE 1. COMPETENT NATIONAL AUTHORITIES ALBANIA Ministry of Health Department of Pharmacy Tirana Albania Phone: 355-42 - 34636 FAX: 355-42 - 28303 BANGLADESH Department of Narcotics Control (DNC) Ministry of Home Affairs Wage Earners Hostel Complex (Level 8) 71-72, Old Elephant Road (Eskaton Garden), Ramna Dhaka 1000, Bangladesh Phone: 880-2 - 831 2131 Fax: 880-2 - 831 1155 E-mail: dgdnc@bttb.net.bd INDIA Central Bureau of Narcotics Ministry of Finace 19, The Mall Morar Gwalior 474006 Madhya Pradesh India Phone: 91-751 236 8996 Phone: 91-751 236 8997 Phone: 91-751 236 8121 Fax: 91-751 236 8111 Fax: 91-751 236 8577 Email: narcom@sancharnet.in KYRGYZSTAN State Service on Drugs Control of the Kyrgyz Republic 80 Toktogula Street Bishkek 720021 The Kyrgyz Republic Phone: 996-312 - 662217 Fax: 996-312 - 625143 Web: www.gskn.kg SRI LANKA Medical Supplies Division 357, Deans Road Colombo 10 Sri Lanka Phone: 94-1 - 694-111 Fax: 94-1 - 697-096 UKRAINE State Service on Drugs Contol Prospect Chervonozoryanyi 51 03680 Kiev Phone: 380-44 - 275-6814 Fax: 380-44 - 275-4287 E-mail: info@narko.gov.ua Web: www.narko.gov.ua 7
V. TABLE 2. STATUS OF ADHERENCE TO CONVENTIONS, RECEIPT OF STATISTICS, AND ESTIMATES Adherence Consumption Statistics Estimated requirements Single Convention 1961 As amended 1961/72 for 2010 for 2012 Albania Bangladesh India Kyrgyzstan Sri Lanka Ukraine = report received 8
VI. GLOBAL CONSUMPTION TRENDS Graph 1. Global Consumption of Morphine, Oxycodone, Pethidine and Methadone, 1980-2010 Kilograms Source: International Narcotics Control Board By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 9
Graph 2. Global Consumption Fentanyl and Hydromorphone, 1980-2010 Kilograms Source: International Narcotics Control Board By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 10
VII. GLOBAL CONSUMPTION, 2010 Graph 3. Global Consumption of Morphine, 2010 mg/capita 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 11
TABLE 3: Global Morphine Consumption, 2010: (mg/capita) Note: Countries not listed either did not report, or reported an amount of zero (0) for morphine consumption, to the INCB for 2010 1 Austria 122.5037 52 Cayman Islands 1.8393 103 Kenya 0.2988 2 United States of America 73.6764 53 Colombia 1.7470 104 Kuwait 0.2667 3 United Kingdom 56.4189 54 Andorra 1.6471 105 Philippines 0.2600 4 Denmark 55.9755 55 Jamaica 1.6012 106 Venezuela 0.2559 5 Canada 51.5401 56 Brunei Darussalam 1.5639 107 Montenegro 0.2155 6 Australia 45.1398 57 Trinidad and Tobago 1.5466 108 Cape Verde 0.2097 7 Switzerland 42.4165 58 Lebanon 1.4586 109 Kazakhstan 0.2059 8 Iceland 35.1031 59 Georgia 1.4242 110 Dominica 0.2059 9 France 34.2643 60 Singapore 1.3985 111 Egypt 0.1818 10 New Zealand 30.8246 61 Cuba 1.3080 112 Ecuador 0.1676 11 Slovenia 24.9522 62 Bahamas 1.2915 113 Montserrat 0.1667 12 Norway 24.8128 63 Saint Lucia 1.2874 114 United Arab Emirates 0.1664 13 Sweden 22.2949 64 Republic of Korea 1.2756 115 Madagascar 0.1623 14 Germany 22.2097 65 Cook Islands 1.2500 116 Nepal 0.1412 15 Belgium 13.6856 66 Republic of Moldova 1.1931 117 Mozambique 0.1344 16 Netherlands 11.3352 67 Thailand 1.1596 118 Algeria 0.1325 17 South Africa 10.9355 68 Macao 0.9963 119 Uzbekistan 0.1294 18 Spain 8.9139 69 Albania 0.9429 120 Syrian Arab Republic 0.1242 19 Malta 8.5132 70 Hungary 0.9119 121 Mauritius 0.1155 20 Ireland 8.3369 71 Kiribati 0.8500 122 Panama 0.1143 21 Luxembourg 7.8738 72 Malaysia 0.7303 123 Cameroon 0.1087 22 New Caledonia 7.2988 73 China 0.7239 124 Kyrgyzstan 0.1048 23 Slovakia 6.6276 74 Portugal 0.7178 125 Turkey 0.0953 24 Bulgaria 5.7166 75 Wallis and Futuna Islands 0.7143 126 Turkmenistan 0.0936 25 Poland 5.3904 76 Haiti 0.6920 127 India 0.0913 26 Mexico 5.2807 77 Bosnia and Herzegovina 0.6750 128 Azerbaijan 0.0874 27 Gibraltar 5.2414 78 Guyana 0.6419 129 Guatemala 0.0808 28 French Polynesia 5.1956 79 Ukraine 0.6418 130 Bolivia 0.0755 29 Brazil 5.1328 80 Dem. Peop. Rep. of Korea 0.6367 131 Ghana 0.0693 30 Finland 4.4993 81 Belarus 0.6015 132 Dem. Rep. of the Congo 0.0605 31 Seychelles 4.4713 82 Saudi Arabia 0.5832 133 Indonesia 0.0568 32 Czech Republic 4.2606 83 Tonga 0.5673 134 Zimbabwe 0.0558 33 Israel 4.0801 84 Oman 0.5474 135 Bangladesh 0.0502 34 Bhutan 3.9738 85 Anguilla 0.5333 136 Grenada 0.0481 35 Chile 3.9662 86 St Vincent & Grenadines 0.5321 137 Iraq 0.0465 36 Italy 3.9433 87 El Salvador 0.4886 138 Mali 0.0265 37 Costa Rica 3.8176 88 Russian Federation 0.4746 139 Chad 0.0183 38 Uruguay 3.6646 89 Viet Nam 0.4587 140 Afghanistan 0.0158 39 Estonia 3.6547 90 Nicaragua 0.4502 141 Yemen 0.0141 40 Hong Kong SAR 3.2108 91 Peru 0.4385 142 Honduras 0.0139 41 Argentina 2.9280 92 Zambia 0.4309 143 Tajikistan 0.0125 42 Namibia 2.6776 93 Serbia 0.4260 144 Togo 0.0119 43 Croatia 2.6303 94 Uganda 0.4260 145 Botswana 0.0115 44 Japan 2.6191 95 Tuvalu 0.4000 146 Benin 0.0060 45 Lithuania 2.5457 96 Armenia 0.3904 147 Eritrea 0.0040 46 Tunisia 2.3591 97 Qatar 0.3900 148 Lao Peop. Dem. Rep. 0.0034 47 Mongolia 2.3091 98 Sri Lanka 0.3872 149 Myanmar 0.0031 48 Cyprus 2.2020 99 Dominican Republic 0.3609 150 Côte d'ivoire 0.0031 49 Bahrain 1.9723 100 Greece 0.3581 151 Angola 0.0018 50 Latvia 1.9285 101 Morocco 0.3381 152 Malawi 0.0011 51 Jordan 1.8760 102 United Rep of Tanzania 0.3102 Source: International Narcotics Control Board; World Health Organization population data Pain & Policy Studies Group University of Wisconsin Carbone Cancer Center WHO Collaborating Center 12
mg/capita Graph 4. Global Consumption of Fentanyl, 2010 Sri Lanka 0.0008 Albania 0.0093 Ukraine 0.0080 Kyrgyzstan 0.0026 India 0.0016 149 countries Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 Bangladesh 0.0001 13
TABLE 4: Global Fentanyl Consumption, 2010: (mg/capita) Note: Countries not listed either did not report, or reported an amount of zero (0) for fentanyl consumption, to the INCB for 2010 1 Germany 2.9577 51 Saudi Arabia 0.0428 101 Armenia 0.0045 2 Gibraltar 2.7899 52 Mauritius 0.0414 102 Kazakhstan 0.0045 3 Austria 2.4817 53 Belarus 0.0404 103 Syrian Arab Republic 0.0041 4 Canada 2.1289 54 Cyprus 0.0396 104 Trinidad and Tobago 0.0031 5 Belgium 2.0449 55 Macao 0.0370 105 Mongolia 0.0028 6 Spain 1.9998 56 Panama 0.0339 106 Kyrgyzstan 0.0026 7 Switzerland 1.9574 57 Lebanon 0.0327 107 St Vincent & Grenadines 0.0019 8 United States of America 1.6448 58 Bhutan 0.0324 108 Philippines 0.0018 9 Denmark 1.5397 59 Jordan 0.0323 109 Yemen 0.0018 10 Luxembourg 1.2980 60 Bulgaria 0.0316 110 Azerbaijan 0.0017 11 Finland 1.2927 61 Colombia 0.0285 111 India 0.0016 12 France 1.2596 62 Bahrain 0.0272 112 Indonesia 0.0012 13 Norway 1.2104 63 Venezuela 0.0243 113 Iceland 0.0011 14 Sweden 1.1649 64 Uruguay 0.0214 114 Mozambique 0.0011 15 Ireland 0.9546 65 United Arab Emirates 0.0200 115 Uzbekistan 0.0009 16 Greece 0.9061 66 Malta 0.0180 116 Tonga 0.0008 17 Netherlands 0.8498 67 Bahamas 0.0166 117 Sri Lanka 0.0008 18 United Kingdom 0.7408 68 Malaysia 0.0166 118 Grenada 0.0008 19 Australia 0.7329 69 Qatar 0.0165 119 Angola 0.0007 20 Slovenia 0.7157 70 Brunei Darussalam 0.0160 120 Botswana 0.0005 21 Hungary 0.6880 71 Tunisia 0.0158 121 Turkmenistan 0.0005 22 Czech Republic 0.6307 72 Hong Kong SAR 0.0153 122 Anguilla 0.0005 23 Cayman Islands 0.6288 73 El Salvador 0.0150 123 Zimbabwe 0.0004 24 Israel 0.5913 74 Costa Rica 0.0145 124 Côte d'ivoire 0.0004 25 Slovakia 0.5681 75 Namibia 0.0140 125 Cook Islands 0.0004 26 Italy 0.5573 76 Russian Federation 0.0135 126 Tajikistan 0.0004 27 New Caledonia 0.4313 77 Oman 0.0130 127 Mali 0.0003 28 Croatia 0.4303 78 Thailand 0.0130 128 Nepal 0.0003 29 Andorra 0.4129 79 Ecuador 0.0128 129 Togo 0.0003 30 Republic of Korea 0.4071 80 China 0.0123 130 Madagascar 0.0002 31 New Zealand 0.3949 81 Egypt 0.0105 131 Dominica 0.0002 32 Portugal 0.3471 82 Cuba 0.0102 132 Kiribati 0.0002 33 French Polynesia 0.3403 83 Mexico 0.0100 133 Iraq 0.0002 34 South Africa 0.3013 84 Peru 0.0094 134 Lao Peop. Dem. Rep. 0.0002 35 Poland 0.2758 85 Albania 0.0093 135 Kenya 0.0002 36 Montenegro 0.2648 86 Georgia 0.0089 136 Saint Lucia 0.0001 37 Serbia 0.2648 87 Jamaica 0.0086 137 Guyana 0.0001 38 Lithuania 0.2447 88 Macedonia (TfYR) 0.0085 138 Bangladesh 0.0001 39 Japan 0.2293 89 Nicaragua 0.0084 139 Zambia 0.00002 40 Latvia 0.1694 90 Morocco 0.0082 140 Benin 0.00002 41 Wallis and Futuna Islands 0.1445 91 Ukraine 0.0080 141 Myanmar 0.00002 42 Republic of Palau 0.1300 92 Seychelles 0.0075 142 Chad 0.00001 43 Turkey 0.1299 93 Algeria 0.0075 143 Ghana 0.00001 44 Argentina 0.1109 94 Republic of Moldova 0.0069 144 Afghanistan 0.00001 45 Bosnia and Herzegovina 0.1024 95 Cape Verde 0.0058 145 Cameroon 0.00001 46 Estonia 0.0779 96 Honduras 0.0055 146 Haiti 0.000004 47 Chile 0.0629 97 Dominican Republic 0.0054 147 Bolivia 0.000004 48 Singapore 0.0618 98 Iran (Islamic Republic of) 0.0053 148 Dem. Rep. of the Congo 0.000001 49 Brazil 0.0608 99 Guatemala 0.0051 149 Eritrea 0.000001 50 Kuwait 0.0491 100 Viet Nam 0.0047 Source: International Narcotics Control Board; World Health Organization population data Pain & Policy Studies Group University of Wisconsin Carbone Cancer Center WHO Collaborating Center 14
Graph 5. Global Consumption of Hydromorphone, 2010 mg/capita No consumption data available for attending Fellows countries 47 countries Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 15
TABLE 5 Global Hydromorphone Consumption, 2010: (mg/capita) Note: Countries not listed either did not report, or reported an amount of zero (0) for hydromorphone consumption, to the INCB for 2010 1 Canada 24.8193 2 Austria 8.9301 3 United States of America 6.1322 4 Germany 4.6407 5 Denmark 2.3714 6 Switzerland 1.6878 7 Luxembourg 1.4951 8 Sweden 1.3478 9 Australia 1.0875 10 Czech Republic 0.9736 11 Belgium 0.8883 12 Slovenia 0.8069 13 Slovakia 0.7257 14 France 0.6432 15 Hungary 0.6415 16 Spain 0.5324 17 Ireland 0.4828 18 Cayman Islands 0.4643 19 Italy 0.4348 20 Serbia 0.3508 21 Kuwait 0.3252 22 New Caledonia 0.2151 23 Republic of Korea 0.2018 24 United Kingdom 0.1573 25 Iceland 0.1406 26 Finland 0.1316 27 Portugal 0.1030 28 Netherlands 0.0663 29 Norway 0.0610 30 Colombia 0.0331 31 Singapore 0.0315 32 Croatia 0.0288 33 United Arab Emirates 0.0234 34 Belarus 0.0218 35 Saudi Arabia 0.0176 36 Brazil 0.0174 37 Mexico 0.0155 38 Turkey 0.0139 39 Argentina 0.0124 40 Israel 0.0105 41 Jordan 0.0052 42 Poland 0.0036 43 Egypt 0.0018 44 China 0.0003 45 Venezuela 0.0002 46 Japan 0.0001 47 Philippines 0.00003 Sources: International Narcotics Control Board; World Health Organization population data Pain & Policy Studies Group University of Wisconsin Carbone Cancer Center WHO Collaborating Center 16
Graph 6. Global Consumption of Oxycodone, 2010 mg/capita No consumption data available for attending Fellows countries 69 countries Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 17
TABLE 6: Global Oxycodone Consumption, 2010: (mg/capita) Note: Countries not listed either did not report, or reported an amount of zero (0) for morphine consumption, to the INCB for 2010 1 United States of America 190.0460 36 New Caledonia 1.1793 2 Canada 164.8810 37 Bulgaria 1.0786 3 Australia 73.4317 38 Colombia 1.0741 4 Denmark 63.6195 39 Hungary 0.7655 5 Norway 37.5173 40 Singapore 0.5580 6 Sweden 33.0781 41 El Salvador 0.5472 7 Finland 30.6913 42 Argentina 0.4868 8 Germany 29.7430 43 Kuwait 0.4750 9 New Zealand 27.9858 44 Venezuela 0.3873 10 Switzerland 21.8160 45 Peru 0.3027 11 Cayman Islands 19.7321 46 Malaysia 0.2519 12 Ireland 18.0705 47 Guatemala 0.2439 13 Israel 16.4621 48 Poland 0.2326 14 United Kingdom 16.0072 49 Chile 0.2081 15 Netherlands 14.7941 50 Ecuador 0.2073 16 Iceland 13.7875 51 Costa Rica 0.1548 17 France 12.9877 52 Dominican Republic 0.1296 18 Belgium 8.4656 53 Brazil 0.1231 19 Italy 7.7339 54 Honduras 0.1172 20 Slovenia 7.4414 55 Philippines 0.1030 21 Czech Republic 6.9671 56 Jordan 0.0845 22 Austria 6.6721 57 Mexico 0.0793 23 Republic of Korea 5.9010 58 Panama 0.0680 24 Andorra 5.0235 59 China 0.0620 25 Spain 4.5943 60 Bolivia 0.0601 26 Slovakia 4.0007 61 Latvia 0.0373 27 Estonia 3.5928 62 Saudi Arabia 0.0345 28 Japan 3.3796 63 Nicaragua 0.0251 29 Cyprus 3.0797 64 French Polynesia 0.0148 30 Hong Kong SAR 3.0001 65 Qatar 0.0125 31 Gibraltar 2.8276 66 United Arab Emirates 0.0039 32 Bahamas 2.7405 67 Serbia 0.0016 33 Syrian Arab Republic 1.7638 68 Lithuania 0.0003 34 Luxembourg 1.5937 69 South Africa 0.0001 35 Croatia 1.3650 Source: International Narcotics Control Board; World Health Organization population data Pain & Policy Studies Group University of Wisconsin Carbone Cancer Center WHO Collaborating Center 18
Graph 7. Global Consumption of Pethidine, 2010 45 mg/capita Global mean, 1.1895 mg 40 35 30 25 20 15 Sri Lanka 0.6664 10 Bangladesh 0.6120 5 122 countries Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 India 0.0419 0 19
TABLE 7: Global Pethidine Consumption, 2010 (mg/capita) Note: Countries not listed either did not report, or reported an amount of zero (0) for pethidine consumption, to the INCB for 2010 1 Cayman Islands 42.6607 42 Portugal 2.4701 83 Nepal 0.6334 2 Canada 29.6585 43 Brunei Darussalam 2.4637 84 Hungary 0.6333 3 Bahamas 17.7551 44 Oman 2.4112 85 Bangladesh 0.6120 4 St Vincent & Grenadines 16.3211 45 Macao 2.3824 86 Colombia 0.6120 5 Bhutan 9.6488 46 Iran (Islamic Republic of) 2.3587 87 Cuba 0.5931 6 United States of America 9.1438 47 Singapore 2.3008 88 Peru 0.5482 7 Dominica 9.0000 48 Turkey 2.2979 89 Slovenia 0.5399 8 Saint Lucia 8.6839 49 Malawi 2.2947 90 Japan 0.4801 9 Trinidad and Tobago 8.5086 50 Brazil 2.2292 91 Viet Nam 0.4706 10 Denmark 8.2532 51 Greece 2.1674 92 Tunisia 0.4371 11 Switzerland 7.6961 52 Tonga 2.1058 93 Finland 0.4121 12 New Zealand 7.5453 53 Belgium 1.9379 94 Cape Verde 0.4052 13 Jamaica 5.8719 54 El Salvador 1.8267 95 Uganda 0.3459 14 Mauritius 5.6243 55 Kiribati 1.6800 96 Togo 0.3449 15 Kuwait 5.4556 56 South Africa 1.6629 97 Latvia 0.3179 16 Bahrain 4.9033 57 Ireland 1.6403 98 Iraq 0.2905 17 Cook Islands 4.8000 58 Saudi Arabia 1.6148 99 Botswana 0.2427 18 Republic of Palau 4.7000 59 Zimbabwe 1.5295 100 Lao Peop. Dem. Rep. 0.1898 19 Cyprus 4.5625 60 Kenya 1.3898 101 Indonesia 0.1748 20 Norway 4.5460 61 Qatar 1.3451 102 Philippines 0.1688 21 Czech Republic 4.4447 62 Slovakia 1.2475 103 Zambia 0.1662 22 Malta 4.3381 63 Chile 1.2253 104 France 0.1628 23 Jordan 3.9266 64 Germany 1.1951 105 French Polynesia 0.1587 24 Republic of Korea 3.7668 65 Sweden 1.1590 106 Yemen 0.1406 25 Guyana 3.7334 66 Guatemala 1.0997 107 United Republic of Tanzania 0.1396 26 Malaysia 3.7000 67 Netherlands 1.0692 108 Eritrea 0.1178 27 United Kingdom 3.4304 68 Thailand 1.0480 109 Gibraltar 0.1034 28 Israel 3.4215 69 United Arab Emirates 1.0450 110 Bosnia and Herzegovina 0.0785 29 Lebanon 3.3600 70 Tuvalu 1.0000 111 Mozambique 0.0770 30 Lithuania 3.0933 71 Iceland 0.9344 112 Costa Rica 0.0738 31 Namibia 3.0845 72 Croatia 0.9085 113 Algeria 0.0582 32 Syrian Arab Republic 3.0704 73 Andorra 0.8824 114 Bolivia 0.057 33 Australia 2.9721 74 China 0.8309 115 India 0.0419 34 Spain 2.8322 75 Austria 0.8057 116 Ghana 0.0357 35 Grenada 2.7596 76 Argentina 0.7695 117 Honduras 0.0133 36 Poland 2.6818 77 Luxembourg 0.7436 118 Myanmar 0.0106 37 Anguilla 2.6667 78 Egypt 0.7396 119 Dem. Rep. of the Congo 0.0101 38 Montserrat 2.6667 79 Italy 0.7250 120 Chad 0.0043 39 Bulgaria 2.6026 80 Panama 0.7123 121 Angola 0.0038 40 Estonia 2.5444 81 Montenegro 0.6894 122 Cameroon 0.0029 41 Seychelles 2.4713 82 Sri Lanka 0.6664 Source: International Narcotics Control Board; World Health Organization population data Pain & Policy Studies Group University of Wisconsin Carbone Cancer Center WHO Collaborating Center 20
Graph 8. Global Consumption of Methadone, 2010 60 mg/capita Global mean, 4.5771 mg/capita 50 40 30 20 10 Kyrgyzstan 3.8112 Ukraine 1.9473 Albania 1.4110 90 countries Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 Sri Lanka 0.0008 0 21
TABLE 8: Global Methadone Consumption, 2010: (mg/capita) Note: Countries not listed either did not report, or reported an amount of zero (0) for methadone consumption, to the INCB for 2010 1 Switzerland 54.6227 46 Republic of Moldova 1.5416 2 New Zealand 49.9402 47 Albania 1.4110 3 United States of America 49.2489 48 Hungary 1.3109 4 United Kingdom 48.3590 49 China 1.1505 5 Denmark 46.7463 50 Costa Rica 1.0996 6 Ireland 44.4749 51 Slovakia 0.9965 7 Canada 43.4143 52 Poland 0.9285 8 Australia 35.4903 53 Armenia 0.8486 9 Mauritius 34.2494 54 Mexico 0.6164 10 Malta 32.6139 55 Indonesia 0.5182 11 Portugal 30.8281 56 Myanmar 0.4691 12 Belgium 29.9685 57 Azerbaijan 0.4626 13 Spain 28.2591 58 Republic of Palau 0.4500 14 Netherlands 25.6664 59 Chile 0.3719 15 Luxembourg 25.5720 60 Thailand 0.3637 16 Norway 22.1986 61 Namibia 0.2838 17 Italy 20.1963 62 New Caledonia 0.2390 18 Croatia 17.7692 63 Colombia 0.2173 19 TfYR of Macedonia 17.4920 64 Brazil 0.1791 20 Israel 16.9655 65 Cayman Islands 0.1786 21 Hong Kong SAR 16.5764 66 El Salvador 0.1465 22 Malaysia 16.1931 67 Viet Nam 0.1328 23 Slovenia 15.2453 68 Saudi Arabia 0.1227 24 France 15.1815 69 French Polynesia 0.1218 25 Iran (Islamic Republic of) 12.1664 70 United Rep of Tanzania 0.1115 26 Bulgaria 11.7362 71 Saint Lucia 0.1034 27 Estonia 11.2774 72 Uruguay 0.1033 28 Germany 11.0628 73 Nepal 0.0843 29 Sweden 8.8060 74 Uzbekistan 0.0477 30 Austria 7.5942 75 Cyprus 0.0462 31 Finland 6.8410 76 Qatar 0.0341 32 Bosnia and Herzegovina 6.6726 77 Singapore 0.0322 33 Macao 6.1213 78 South Africa 0.0320 34 Montenegro 4.2789 79 Afghanistan 0.0239 35 Kyrgyzstan 3.8112 80 Venezuela 0.0224 36 Greece 3.7778 81 Guatemala 0.0220 37 Lithuania 3.6805 82 Jordan 0.0168 38 Georgia 3.4216 83 Kuwait 0.0164 39 Andorra 3.2353 84 Bahrain 0.0127 40 Serbia 3.2283 85 Japan 0.0113 41 Belarus 2.9490 86 Peru 0.0038 42 Latvia 2.1834 87 United Arab Emirates 0.0009 43 Iceland 2.0875 88 Sri Lanka 0.0008 44 Ukraine 1.9473 89 Kenya 0.0003 45 Czech Republic 1.5457 90 Morocco 0.0002 Sources: International Narcotics Control Board; World Health Organization population data Pain & Policy Studies Group University of Wisconsin Carbone Cancer Center WHO Collaborating Center 22
mg/capita VIII. Regional Consumption, 2010 Graph 9. AFRO Regional 2010 Morphine Consumption Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 23
Graph 10. AFRO Regional 2010 Fentanyl 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 24
Graph 11. AFRO Regional 2010 Hydromorphone 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 25
Graph 12. AFRO Regional 2010 Oxycodone 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 26
Graph 13. AFRO Regional 2010 Pethidine 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 27
Graph 14. AFRO Regional 2010 Methadone Consumption mg/capita Mauritius 34.2494 Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 28
Graph 15. AMRO Regional 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 29
Graph 16. AMRO Regional 2010 Fentanyl Consumption mg/capita Canada 2.1289 USA 1.6448 Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 30
Graph 17. AMRO Regional 2010 Hydromorphone 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 31
Graph 18. AMRO Regional 2010 Oxycodone Consumption mg/capita Canada 164.8810 Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 32
Graph 19. AMRO Regional 2010 Pethidine Consumption mg/capita Canada 29.6585 Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 33
Graph 20. AMRO Regional 2010 Methadone Consumption mg/capita Canada 43.4143 Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 34
Graph 21. EMRO Regional 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 35
Graph 22. EMRO Regional 2010 Fentanyl 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 36
Graph 23. EMRO Regional 2010 Hydromorphone 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 37
Graph 24. EMRO Regional 2010 Oxycodone 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 38
Graph 25. EMRO Regional 2010 Pethidine 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 39
Graph 26. EMRO Regional 2010 Methadone Consumption mg/capita Iran 12.1664 Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 40
Graph 27. EURO Regional 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 41
Graph 28. EURO Regional 2010 Fentanyl 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 42
Graph 29. EURO Regional 2010 Hydromorphone 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 43
Graph 30. EURO Regional 2010 Oxycodone 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 44
Graph 31. EURO Regional 2010 Pethidine 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 45
Graph 32. EURO Regional 2010 Methadone 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 46
Graph 33. SEARO Regional 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 47
Graph 34. SEARO Regional 2010 Fentanyl 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 48
Graph 35. SEARO Regional 2010 Hydromorphone 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 49
Graph 36. SEARO Regional 2010 Oxycodone 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 50
Graph 37. SEARO Regional 2010 Pethidine 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 51
Graph 38. SEARO Regional 2010 Methadone 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 52
Graph 39. WPRO Regional 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 53
Graph 40. WPRO Regional 2010 Fentanyl 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 54
Graph 41. WPRO Regional 2010 Hydromorphone 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 55
Graph 42. WPRO Regional 2010 Oxycodone 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 56
Graph 43. WPRO Regional 2010 Pethidine 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 57
Graph 44. WPRO Regional 2010 Methadone Consumption mg/capita New Zealand 49.9402 Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2012 58
IX. NATIONAL CONSUMPTION TRENDS, 2010 59
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X. MORPHINE EQUIVALENCE: GLOBAL AND NATIONAL TRENDS, 1980-2010 Graph 81. Morphine Equivalence Global Consumption, 1980-2010 (ME), Mg/person 70 Fentanyl ME 60 Hydromorphone ME Methadone ME Morphine ME 50 Oxycodone ME Pethidine ME Total ME 40 30 20 10 0 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 77
TABLE 9: GLOBAL Opioid Consumption in Morphine Equivalence (ME), Mg per person Fentanyl ME Hydromorphone ME Methadone ME Morphine ME Oxycodone ME Pethidine ME Total ME 1980 0.08 0.20 0.45 0.43 0.39 0.27 1.82 1981 0.09 0.21 0.48 0.47 0.37 0.25 1.87 1982 0.09 0.23 0.49 0.40 0.39 0.25 1.85 1983 0.10 0.25 0.49 0.44 0.41 0.27 1.96 1984 0.11 0.26 0.50 0.56 0.46 0.26 2.15 1985 0.11 0.26 0.53 0.68 0.44 0.25 2.27 1986 0.12 0.29 0.52 0.88 0.46 0.24 2.51 1987 0.38 0.89 1.80 0.94 1.53 0.75 6.29 1988 0.54 0.94 1.87 1.14 1.51 0.78 6.78 1989 0.45 1.00 2.01 1.24 1.58 0.76 7.04 1990 0.61 1.07 2.36 1.35 1.64 0.64 7.67 1991 1.57 1.16 2.41 1.55 1.61 0.73 9.03 1992 1.64 1.22 2.62 1.82 1.73 0.71 9.74 1993 1.64 1.32 3.12 2.25 1.75 0.66 10.74 1994 2.27 1.36 3.80 2.48 1.96 0.61 12.48 1995 2.75 1.62 4.42 2.66 1.96 0.67 14.08 1996 3.02 1.70 5.28 2.79 2.37 0.62 15.78 1997 3.96 1.80 5.72 3.03 3.36 0.60 18.47 1998 5.14 2.76 6.38 3.28 4.32 0.62 22.50 1999 6.74 2.31 7.72 3.35 6.89 0.59 27.60 2000 8.47 2.53 8.05 3.49 10.13 0.59 33.26 2001 9.65 3.23 9.23 3.77 12.83 0.59 39.30 2002 12.98 4.12 10.55 4.33 14.64 0.61 47.23 2003 16.85 4.61 11.81 4.39 17.75 0.49 55.90 2004 21.09 1.08 13.43 4.49 7.64 0.55 48.28 2005 12.89 1.39 13.85 4.88 8.71 0.45 42.17 2006 16.29 1.52 15.42 4.95 8.60 0.40 47.18 2007 16.78 1.66 16.94 5.89 10.30 0.37 51.94 2008 18.44 1.69 18.15 5.67 10.54 0.36 54.85 2009 16.64 2.69 18.78 6.15 15.03 0.37 59.66 2010 16.70 2.49 18.31 5.99 14.32 0.30 58.11 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 78