Opioid pain management and palliative care are key components of UHC and a human right
Dear Neil and HIFA colleagues,
Access to timely, affordable opioids for pain relief at the point of care is essential. They are crucial, particularly for perioperative care and palliative care. Although opioids are listed in the WHO’s Essential Medicine List and the WHO’s Pain Relief Ladder, there is a significant inequity in global availability. While 92% of the available opioids are consumed in high-income countries, only 8% are distributed among LMICs, as noted by the International Association for the Study of Pain, resulting in people seeking illicit opioids for pain relief.
National Health Policies, including Medical Regulatory bodies, are responsible for the availability and delivery of this medication. Pain management and palliative care are key components of universal health coverage and a human right. The Lancet Commission on Palliative Care recommended ‘the Essential Package’ for universal accessibility to opioids in a primary care setting. It proposes using off-patent formulations instead of expensive opioids, which may help in reducing misuse and profit-driven motives. (ref. Balancing global access to opioids, The Lancet Global Health, Vol. 12, July 2024).
While it is critical to ensure that patients requiring opioids have access to affordable, high-quality opioids prescribed by trained healthcare professionals, at the same time, the illicit use of opioids is escalating in several LMICs and becoming a huge public health challenge. The WHO has made updates in April 2026 to its guidelines on treating opioid dependence and managing opioid overdose in communities.
Best wishes
Dr. Meena Nathan Cherian, MBBS, MD (Anaesthesia)
(Former WHO Lead Emergency and Essential Surgical Care Program, Geneva, Switzerland).
Director, Global Health New Challenges: Geneva Foundation for Medical Education & Research, Switzerland. www.gfmer.ch/surgery/cancer.htm (NSA-WHO)
Senior Advisor Global Action International Society of Geriatric Oncology Permanent Committees - SIOG
Senior Advisor, International College of Surgeons-Global Affairs. https://icsglobal.org/ (NSA-WHO)
Adjunct Prof.The Chinese University of Hong Kong,Shenzhen,China. https://med.cuhk.edu.cn/en/teacher/371
WHO-HIFA Essential Health Services; mHEALTH-INNOVATE. www.hifa.org (NSA-WHO).
Geneva, Switzerland. +41 763837253(m); cherianm15@gmail.com
HIFA profile: Dr Meena Nathan Cherian was a professor of anaesthesiology from Christian Medical College Hospital, Vellore, India. She trained, worked, and taught in several countries, USA (Johns Hopkins Hospital), Southeast Asia and Africa. She worked at the World Health Organization Headquarters, Geneva, Switzerland, as the Emergency and Essential Surgical Care Program Lead where she created the ‘surgical care’ program resulting in the first World Health Assembly Resolution on ‘Emergency and Essential Surgical Care and Anaesthesia in the context of Universal Health Coverage’. Currently she works as the Director, Global Health New Challenges program, Geneva Foundation for Medical Education and Research, Geneva, Switzerland; Adjunct Prof. The Chinese University of Hong Kong, Shenzhen, China; Senior Advisor, Global Action, International Society of Geriatric Oncology, Switzerland; Member of the WHO-HIFA Working Group on Essential Health Services and COVID-19; and HIFA mHEALTH-INNOVATE Working Group. She is a member of the HIFA Steering Group. https://www.hifa.org/support/members/meena cherianm15 AT gmail.com