Accès aux analgésiques opioïdes pour les douleurs cancéreuses : des inégalités majeures - la situation en Afrique

Although the 1961 Convention on Narcotic Drugs was intended to ensure (rather than unduly restrict) access to drugs that were considered to be essential for medical and scientific purposes, access to opioid analgesics is inadequate in many countries. Indeed, more than 5 billion people worldwide have little or no access to essential analgesics like codeine and morphine. A study of 214 countries published in 2016 evidenced an increase in the worldwide consumption of opioid analgesic medicines between 2001-2003 and 2011-2013. However, there are major disparities in consumption from one region to another. The great majority of opioid analgesic consumption (95.7%) takes place in North America, Oceania and western and central Europe, even though these regions account for only 15% of the world's population. At the same time, 75% of the world's population (predominantly those in lower-income countries in Africa, Asia, the Caribbean, and South and Central America) have little or no access to adequate pain relief. Low levels of opioid analgesic use in these countries and regions do not seem to result from a lack of opiate raw materials or opioids (i.e. supply). Data from the International Narcotics Control Board (INCB) indicate that global demand is fully met. The most frequently identified impediments to availability include an absence of training and awareness among medical professionals, fear of dependence, limited financial resources, issues in sourcing, cultural/social attitudes, fear of diversion, international trade controls, and an onerous regulatory framework. The INCB has issued guidelines for application over the next ten years; hopefully, these guidelines will reinforce the provisions of the Single Convention on Narcotic Drugs and thus attenuate regional disparities in pain relief.