Annually, more than 61 million people worldwide experience about 6 billion days of serious health-related suffering that could be alleviated with access to palliative care and pain relief. However, palliative care is limited or nonexistent in most parts of the world. The access abyss is so stark that 50% of the world’s poorest populations live in countries that receive only 1% of the opioid analgesics distributed worldwide. By contrast, the richest 10% of the world’s population live in countries that receive nearly 90% of the opioid pain relief medications. The Lancet Commission on Global Access to Palliative Care and Pain Relief developed a framework to measure the global burden of serious health-related suffering and generated the evidence base to address this burden. We present the inequities in access to pain relief and highlight key points from country responses, drawing from and building on recommendations of the Lancet Commission report “Alleviating the Access Abyss in Palliative Care and Pain Relief—An Imperative of Universal Health Coverage” to close the access abyss in relief of pain and other types of serious health-related suffering. The poor, worldwide, have little or no access to palliative care or pain relief. Approximately 298 metric tons of morphine-equivalent opioids are distributed in the world each year. However, only 0.1 metric tons—0.03%—are distributed to low-income countries. 1 More than 61 million people worldwide experience serious health-related suffering annually throughout the life course that could be alleviated if they had access to palliative care. More than 80% of these individuals reside in low- and middle-income countries where palliative care is limited or nonexistent. 1 This global pain crisis counts among the most serious health and equity imperatives facing the world. Yet the barriers to accessing pain relief medications—one of the most basic palliative care interventions—are surmountable. These barriers include “opiophobia” (i.e., prejudice and misinformation on medical use of opioids) among prescribers, social and cultural perceptions of opioids, the neglect of end-of-life care, and a lack of priority-setting tools to incorporate suffering into measurement of health outcomes investment decisions. The Lancet Commission on Global Access to Palliative Care and Pain Relief, in its report, 1 quantified the global burden of serious health-related suffering associated with 20 life-limiting and life-threatening health conditions and identified effective and affordable strategies to address this burden, particularly through the design and estimated cost of an essential package of palliative care health services. 1 Its findings call on governments and global institutions to act collectively to address this grotesque injustice that leaves millions in pain when appropriate interventions exist. 1 We briefly present global inequities surrounding access to pain relief and highlight key points from country responses, drawing from and building on recommendations from the Lancet Commission report.
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