Dear colleagues,
Yesterday I discussed the general public's concerns about opioid abuse. Today I want to shift the focus and talk about these concerns from the perspective of Latin American healthcare systems.
Latin America faces a unique and complex situation regarding opioid use — marked not by excess, but by a profound deficit in access to opioids for legitimate medical purposes, alongside a growing concern about a possible future escalation in misuse. Evidence from recent regional analyses highlights a dual challenge for health systems: expanding access to essential pain treatment while preventing a crisis similar to that observed in high-income countries.
The most pressing issue is the systematic undertreatment of pain, particularly in cancer patients and those requiring palliative care. In several countries, access to opioid analgesics remains extremely limited, with coverage of need reported as low as 1–6%. This has resulted in what can be described as a “silent crisis” of avoidable suffering. Importantly, this gap reflects structural weaknesses in health systems — including restrictive regulations, limited availability, and insufficient professional training — rather than concerns about overuse.
At the same time, demographic and epidemiological trends — such as population aging and the rising burden of chronic diseases — are expected to significantly increase the demand for pain management and palliative care. Health systems must therefore prepare for a necessary expansion in legitimate opioid use, which could be misinterpreted as a signal of misuse if not properly contextualized.
This leads to a critical policy tension: the need to balance access and control.
On one hand, there is a legitimate concern about the potential emergence of non-medical use, particularly with the introduction of more potent opioids and the global dynamics of drug markets.
On the other hand, overly restrictive policies — often driven by fear (“opiophobia”) among regulators and clinicians — risk further limiting access to essential medicines. Evidence suggests that misuse prevalence and opioid-related mortality in Latin America remain relatively low compared to other regions, but data systems are weak, and surveillance capacity is limited.
Another major concern is the lack of training among health professionals, both in pain management and in the safe use of opioids. This contributes to underprescription, poor quality of care, and inadequate identification of potential risks of dependence. Additionally, fragmented regulatory frameworks and insufficient monitoring systems hinder the ability to ensure rational use while preventing diversion.
The region also faces significant inequalities between countries, as well as within them, in access to opioids and palliative care services. These disparities raise ethical and human rights concerns, as access to pain relief is increasingly recognized as a fundamental component of the right to health.
In this context, Latin America stands at a crossroads. The central challenge is not to restrict opioids, but to develop balanced, evidence-based policies that simultaneously:
Close the gap in access to pain treatment
Strengthen health system capacity and professional training
Implement effective monitoring and early warning systems
Prevent misuse without replicating the unintended consequences seen elsewhere
Failure to achieve this balance could either perpetuate unnecessary suffering or create conditions for a future public health crisis. The priority, therefore, is to ensure equitable, safe, and rational access to opioids, integrated within broader health system strengthening and guided by public health principles.
References:
· Palma A, Pérez-Cruz PE, Pettus K, Pastrana T. Opioid use in Latin America: a vital challenge for health systems. J Glob Health. 2025
· León PJ, Altermatt FR, Vega EA, Elgueta MF, Léniz J. Opioid use in Latin America: Chronicle of a death foretold? J Glob Health. 2024
Kind regards,
Eduardo
Eduardo Bianco, MD, MSc, BIR
ATHP Director
Addiction Training for Health Professionals
Email: ebianco@nextgenu.org
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Master's in Prevention and Treatment of Addictive Disorders. Bianco also has a degree in International Relations. Currently, he is Director of International Policy Education in Addictions of the Frank Foundation for International Health and Member of the Interim Policy Committee of the Global Alliance for Tobacco Control (GATC). He had a prominent role in promoting smoking cessation, tobacco control, WHO-FCTC implementation and NCD control in his country (Uruguay) as well as in Latin America for over 25 years. Bianco participated directly in most of the development process of the WHO-Framework Convention on Tobacco control and in the Sessions of the Conference of the Parties to this treaty. He was Director or Tobacco Control Program of InterAmerican Heart Foundation, Regional Coordinator for the Americas of the Framework Convention Alliance (FCA), Chair of the Tobacco Expert Group of the World Heart Federation and Technical Director of the MOH Center for International Cooperation for Tobacco as well as Founder and Former President of the Tobacco Epidemic Research Center (CIET) in Uruguay. Eduardo helps coordinate the HIFA working group on substance use disorders. https://www.hifa.org/support/members/eduardo https://www.hifa.org/projects/mental-health-meeting-information-needs-su...