There is a global crisis in access to
pain management in the world. WHO estimates that 4.65 billion people live in countries where medical
opioid consumption is near to zero. For 2010, WHO considered a per capita consumption of 216.7 mg
morphine equivalents adequate, while Taiwan had a per capita consumption of 0.05 mg
morphine equivalents in 2007. In Asia, the use of
opioids is sensitive because of the
Opium Wars in the 19th century and for this reason, the focus of
controlled substances policies has been on the prevention of diversion and dependence. However, an optimal public health outcome requires that also the beneficial aspects of these substances are acknowledged. Therefore, WHO recommends a policy based on the Principle of Balance: ensuring access for medical and scientific purposes while preventing diversion, harmful use and dependence. Furthermore, international law requires that countries ensure access to
opioid analgesics for medical and scientific purposes. There is evidence that
opioid analgesics for
chronic pain are not associated with a major risk for developing dependence. Barriers for access can be classified in the categories of overly restrictive laws and regulations; insufficient medical training on
pain management and problems related to assessment of medical needs; attitudes like an excessive fear for dependence or diversion; and economic and logistical problems. The GOPI project found many examples of such barriers in Asia. Access to
opioid medicines in Taiwan can be improved by analysing the national situation and drafting a plan. The WHO policy guidelines Ensuring Balance in National Policies on
Controlled Substances can be helpful for achieving this purpose, as well as international guidelines for
pain treatment.